Register

Registration is only required if you do not have a username. Please check your spam & junk mail folders to ensure you have not already received an email with a username and password. If you already have a username log in here

Each account must have a unique email address associated with it. Please contact us if you need multiple accounts with the same email address (i.e. related family members).

You are only a couple of easy steps away from getting the support you and your family deserve. Please complete all required forms and enter a valid credit card for service.

At this point you can self-schedule or send us a secure message through this client portal with a few times you are available and we will get you scheduled and send a confirmation.

Note: One email per registration. If you need to register more than one person with the same email. Please contact us for assistance.

Client Type

Client Information

/ Middle Initial

( optional )
 


( optional )
( optional )





( for Text Message Reminders )


Emergency Contact

First Name
Last Name
Phone
Mobile
Relation
Email
Street Address
City
State
ZIP Code

Log in Details

( If client is a minor, the legal guardian must enter their email address below. )



Between 8 and 40 letters and numbers