Client free registration


Desired ID
Desired Password
Retype Password
Password Hint	Enter a hint for your password that you understand but no one else would understand:
First Name
Last Name
Sex	MF
Date of Birth
email	Use this email address: Re-enter email: email me 2 days before3 days before each appointment, as a reminder. do not remind me of appointments but send me special announcements! email only changes!
phone number
Address 1
Address 2
City
State/Prov.
Postal Code
bill sessions to
claim/ins. number
third party email 1
If there is more than one company or institution paying for various services, fill in the spaces below. If you are paying for services yourself, you don't need to fill in a claim/case number and you don't need to fill in your email address again. Please fill in the payors in order, if possible. For example, you may want to fill in your provincial health plan first if you plan on booking physiotherapy appointments. You can always add third party payors later, if you want.
then bill
claim/ins. number 2
third party email 2
or bill
claim/ins. number 3
third party email 3
or bill
claim/ins. number 4
third party email 4
or bill
claim/ins. number 5
third party email 5
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