The Waynik Group
New User
Register
Confirmation
Home
The Waynik Group
New User
Register
Confirmation
Home
THE WAYNIK GROUP
52 BEACH RD
SUITE 104
FAIRFIELD, CT 06824
Patient Profile
Please type in your information below to verify you are a current patient of the practice.
First Name:
*
Last Name:
*
Date of Birth:
*
Zip Code: (Optional; use if you have a common name)
One or more fields are empty.
Invalid syntax; please check your entry.
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:
*
Clear Signature Pad
One or more fields are empty.
Invalid syntax; please check your entry.
Fields marked with a (
*
) are required.
Register
Request/Registration Confirmation
Thank you
$pat_name
for registering on the
The Waynik Group
patient portal! Your account has been successfully provisioned.
Your portal username is '
$user_name
'. Once you visit the main login page you will be able to login to your online patient portal account.