Register

Registration is only required if you do not have a username. Please check your spam & junk mail folders to ensure you have not already received an email with a username and password. If you already have a username log in here

Each account must have a unique email address associated with it. Please contact us if you need multiple accounts with the same email address (i.e. related family members).

Welcome to Playfair Consulting's secure site. Thank you for taking the time to fill out and review paperwork. Please note any questions you have and we can discuss them at our first meeting. It is super helpful if, in addition to this registration form, you can bring your photo ID to our first meeting and/or send a copy to me ahead of our first visit.

Patient Type

Patient Information

/ Middle Initial

( optional )
 

( MM-DD-YYYY )

( optional )
( optional )







( for Text Message Reminders )

Bill To Contact


/ Middle Initial







Emergency Contact


First Name
Last Name
Phone
Mobile
Relation
Email
Street Address
City
State
ZIP Code

Log in Details

( If patient is a minor, the legal guardian must enter their email address below. )



Between 8 and 40 letters and numbers

Challenge Questions

( These will be used to retrieve your password. Answers must be between 4 and 30 characters, cannot contain any spaces. )




( If you feel you must write down your questions in order to remember them, make sure to keep it in a safe place. )