Patient Registration

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Enabling practices and their patients to stay connected and informed for over 20 years.
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* Name
    
* E-mail Address:
* Username:
* Password
* Confirm Password:
* Phone
* Date of Birth
Who can we thank for referring you?
 
 
Are you completing this form for another person?
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* Verification Code
 

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*This patient registration is for Dr DiRe and Dr Steinbeck’s office. If you reached this link in error or are trying to register for another office, please contact us. After you complete the fields and select the 'Submit' button, you will receive a confirmation email. You’ll need to click the activation link in that email before you can log in to your account.

 
* I certify that the above information is correc