Patient Portal Registration:
Form 2

Note : UPLOAD ISSUES? SKIP UPLOAD BY SELECTING NONE. Photo ID meaning a Drivers License or State ID card and Insurance Card is for Prescription Coverage Only.
*Enter Address Line 2: If Photo ID (Drivers License or State ID) has wrong address or you have alternate address than on Photo ID; or if address on Photo ID is not same as address prescription insurance is under.
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*for doctors notes
Pharmacy Can Be of Preference OR For Patients Who Use Specific Pharmacy. (Ex: RiteAid. Tisdale Rd. 74996.) NO Pharmacy? Input N/A or None.
*Enter address if emergency contact not in same home
Family Account: If you are a guardian for children under 18 list their Name. DOB and SSN in box. Family over 18? No need to create new account. Just make sure each has filled forms 1, 2, & 3 in Family Account profile.