Patient Registration

Patient registration

To complete registration, please enter the requested information below. The information you enter will be validated and must match your current patient pharmacy record to proceed. Tip: You can review your prescription label to confirm how your name is listed.

Note: Your email address will be set as your username when logging in.

Password requirements:
- At least 8 total characters
- At least one lower case letter
- At least one upper case letter
- At least one number
- At least one special character

*Note: Once your account information has been submitted and validated, you will be granted immediate access to the site. All fields marked with a red asterisk are required. (Note: - Registration may take several seconds. Once you click the Register button please wait until the system responds.)

First Name:

Enter a first name.

Last Name:

Enter a last name.

Email Address:

Enter a valid email address.

Password:

Enter your password.

Confirm Password:

Re-enter the password to confirm.