Register with West Holistic Medicine

Welcome to the West Holistic Medicine registration page. To register as a new patient, please enter your information in the fields below. Please do not use this form if you are already a patient. To set up patient portal access or amend your information, please contact us.

If you are already a registered patient with online access, you can log in here

Basic Contact Information

Your Address

Contact Information

Emergency Contact

Insurance Information

Note: Our practice does not bill insurance, but this information makes it easier for us to refer you for other services (like labs or specialists). We will, upon request, provide you with forms to submit to insurance on your own behalf.

Medical Information

Please enter your basic medical information below. You may also add or edit this information after you've signed up.

Set Username and Password for Patient Portal

Please create a username and password that you will use to log into the patient portal in the future.

Your username must be at least 4 characters long

Your password must be at least 8 characters long and include at least one number or special character.

The patient portal gives you access to your medical records and lets you securely communicate with your doctors. When you sign up, you will receive an email with instructions for logging in.

Sign with mouse or finger:

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