Patient Sign Up - ClinIQ360

Patient Portal

Create your account to access your health records

First Name

Last Name

Email Address

We'll use this to match your medical records

Phone Number

Used for account verification and appointment reminders

Date of Birth

Required to verify your identity and match your records

Password

Min 8 characters with uppercase, lowercase, and number

Confirm Password

I agree to the Terms of Service and Privacy Policy

Your health information is protected by HIPAA. We use industry-standard encryption to secure your data.

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