Office Name                                             Name of Doctor, DC,   781-444-3772

Demo 2.  Web Self-Appointment                                                                                                                                            

Saturday, December 16, 2017

Dear Patient! All your personal data submitted to us are stored in the encrypted form on our secure server.
Your information is also encrypted during its trip across the Internet to prohibit viewing by a third party.

Please fill in your 10 digit Contact Phone Number including Area Code, your Date of Birth in MM/DD/YY Format and your Password.
Please always insert the same Phone Number (preferably your Home Phone Number).

If you have never been treated in our Office earlier, please click on the "New Patient" button.
If you are a regular patient, but don't have or don't remember your Password, please click on the "No Password/Forgot Password?" link.


  Phone:   - -
  Date of Birth:   / /  
      
  Password:  
 No Password/Forgot Password?














WSA 02/24/2017

Records of patients who have not made any appointments with us for about 3 years are removed from the Patients List in our Database.
If you have not appeared at our Office for about 3 years and cannot make an appointment while clicking on the "Submit" button, then click on the "New Patient" button and make an appointment as a NEW PATIENT.

    

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