MedicsPremier - Patient Portal

New User

254 Republic Avenue
Joliet, IL 60435

Patient Profile

Please type in your information below to begin the registration process.

First Name: *

Last Name: *

Date of Birth: *

Zip Code: (Optional; use if you have a common name)

Fields marked with a (*) are required.

Online Account

Please select a username for your online patient portal account below.

Username: *

E-Mail: *

Password: *

Confirm Password: *

By clicking on the 'Register' button I have read and understand the Privacy Policy and Terms of Service documents governing the use of this site.

Please sign below: *

Fields marked with a (*) are required.