Register PatientPortal - STI

1-800-487-9135 sales@sticomputer.com

Register PatientPortal

Use the following enrollment form to register your practice with the ChartMaker® PatientPortal. This form is for medical office registration only, and is not for patients.

PatientPortal Registration

Practice Name*
Account Number (can be found on Invoice):*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Contact Name*
First Last
Contact Phone*
Contact Email*
Activation Date*
Date Format: MM slash DD slash YYYY