EmailMeForm
Feel Better In 15-Days Registration
Below is the information to use for my clinic set up
Clinician Name
First
Last
Degree/Certification
Practice Name
Clinic Address
City
State
Zip Code
Clinic Phone
###
-
###
-
####
Email to use for patient correspondence
Public I.P. Address (find at WhatIsMyPublicIP.com)
It should look something like this: 125.25.6315