Emedx-PT Partners - Registration

Registration

Please fill out the form below, all field marked with a * are required. When done, click the 'Submit Registration' button at the bottom of the page.

Terms and Conditions

EMEDx, Inc. does not directly or indirectly practice medicine or dispense medical services. EMEDx, Inc. does not directly or indirectly make any recommendation for any treatment for any medical condition. This site is not to be considered as replacement for a qualified medical diagnosis from a licensed physician.
EMEDx, Inc. disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this informational Web site.
I understand and agree that I will not share my Emedx-PT login details with anyone else. These details are for my use only and I understand if I share them that I may lose my access privilages.
I also understand that all the content on this web site is copyrighted and any unauthorized duplication of material from this site is illegal.

- Check this box to agree to the above terms.

Registration Form
Please enter your details below so we may create an account for you.

Desired User-name: *

Please enter your desired user-name. You will use this when logging in. Your user-name must be at least 6 characters and consist of letters and numbers only.

Desired Password: *

Please enter your desired password. You will use this when logging in. Passwords must be at least 6 characters long and consist of letters and numbers only.

Confirm Password: *

Please confirm the password you entered above.

Email Address: *

Please enter your email address. Please make sure it is correct or you will not receive your login information.

Full Name: *

Please enter your full name.

Your clinic's Web site

How did you find us? *

Your telephone number *