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Before You Register
A copy of your photo ID.
[Preferably your driver's license]. Please make sure this is a clear, enlarged copy with all information being viewable. Our staff reserves the right to request additional proof of identification if the photocopy is not acceptable. a
A Doctor's progress note or other documentation that is indicative of your chief complaint as well as prior medications you have received. MRI, CAT, or X-ray reports are recommended but not required. a
A complete physical exam within the last 18 months.  

:.  Account Information .:
* Denotes a required field
*E-mail Address:
*Verify E-mail:
*Password:
*ReEnter Password:
*First Name:
*Last Name:
*Gender:
*Date of Birth:
*Home Phone: - -
Work Phone: - -
Fax:
*Address:
Address 2:
*City:
*State:
*Zip:

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