Register for a New Account

Fill out the form below in order to create a new account on this system. Once you've successfully registered, you'll be able to log in to the system immediately. Questions marked with a * are required.

Email Address *

First Name *

Last Name *

Age *

Gender *

First or Home Language *

Racial/Ethnic Background (check all that apply) *

Hispanic/Latino

Asian/Asian American

White

Black/African American

Native Hawaiian/Pacific Islander

American Indian/Alaskan Native

Other

No Response

Standing *

School/College *

Student ID (if applicable)

Password

Passwords must be ten or more characters long.

Password *

Re-enter Password *

Email Preferences

Send me an email when my appointments are made, modified or canceled:

YES NO

Send me an email with center announcements or other mass mailings:

YES NO

Send me an email to remind me of my upcoming appointments:

YES NO

Include iCal links with appointment confirmation messages?

YES NO

Text Messaging Preferences

You have the option of receiving appointment reminders and waiting list "appointment available" notices via text message instead of via email.

In order to enable text messaging, enter your ten-digit mobile phone number and select your carrier below. Once saved, you can test text messaging by returning here and selecting the new "test" link below.

Depending on your mobile carrier and plan, you may incur charges for receiving text messages. By entering your number below, you agreee to be responsible for those charges. In order to opt out of receiving future texts, simply remove your number and carrier below.

Mobile Number

Mobile Carrier:

Fake Registration Prevention

In order to help prevent fake or automated registrations on this system, please complete the captcha form below.