Fill out the form below in order to create a new account on this system. Questions marked with a * are required.
Telephone Number:
Age:
*
Gender:
If another gender identity, please specify:
Preferred Pronouns:
If other, please specify:
First or Home Language:
*
If other, please specify:
Standing:
*
School/College:
*
Racial/Ethnic Background:
*
If other, please specify:
Student ID:
*
Send an Email:
When I make an appointment.
When I modify an appointment.
When I delete an appointment.
When an announcement or mass email is sent.
To remind me of my upcoming appointment.
Include iCal Link?
If you use Microsoft Outlook, Mac iCal, or Google Calendar, including iCal information in your appointment-related emails allows you to easily add your appointment to your personal calendar with a single click.
Text Message Options:
You have the option of receiving appointment reminders and waiting list "appointment available" notices via text message instead of via email. If you would prefer to receive text message notices, enter your ten-digit cell phone number and select your carrier below.
Charges may be incurred by sending text messages to your cell phone. You are agreeing to be responsible for such charges by using this optional feature.
CELL PHONE NUMBER (TEN DIGITS, NUMBERS ONLY):
CELL PHONE CARRIER:
