Secure Registration

Personal Information

Security Notice: All data is encrypted using 256-bit SSL encryption and stored in HIPAA-compliant servers.

Account Type *

First Name *

Last Name *

Email Address *

Phone Number *

Format: (123) 456-7890

Date of Birth *

Gender *

Current Physical Location

Required for telehealth compliance

Important: You must be physically located in a state where our providers are licensed. Your current location will be verified for compliance.

Current Address * Where you are physically located right now

ZIP Code *

Enter ZIP to auto-fill city and state

City *

State *

I confirm that I am physically located at the address provided above and understand that telehealth services can only be provided in states where providers are licensed.

Home Address

Your permanent residential address

Street Address *

Address Line 2

ZIP Code *

Enter ZIP code to auto-fill city and state

City *

State *

Location Verification: We use your ZIP code to verify your location and ensure compliance with state telehealth regulations.

Create Password *

Confirm Password *

Security Check

CAPTCHA verified successfully!

Emergency Contact

Contact Name *

Contact Phone *

Back to Login

Personal Information

Current Physical Location

Home Address

Emergency Contact

Welcome to YourMD Telehealth

We need your consent for:

Cookies & Local Storage

Location Access

Camera Access

Microphone Access

Push Notifications

Setting Up Permissions