Join MyPharmAssist

Join as a Patient

Welcome to registration. This is where you create your FREE account and will have access to the FREE "My Meds" section that allows you to keep your medications organized. Please simply fill out the fields below, submit, and you will have access to MyPharmAssist.org. After registration, you will also be able to connect with pharmacists through quick questions and video conferencing.

Fill out the form below to join, fields marked with an asterisk (*) are required.

Your Information

*Your First Name:

*Your Last Name:

* Sex:

Please choose... Male Female Non-binary Prefer not to say

Login Information

* Email Address: (Your email address will be used as your username for logging into the site. Please use a valid email address, as a verification will be sent to this email address to activate your account after registration.)

* Password:

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(Please type a password between 12-16 characters that contains at least one capital letter, one number and one special character.)

* Retype Password:

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(Please retype the same password again.)

* Password Hint: (Your hint will be emailed to you in case you forget your password - we will NEVER email your actual password.)

Address Information

* Address:

* City:

* State:

Please choose... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

(Quick Questions and Video Conferencing are able to operate in the following states: Arkansas, Iowa, Missouri, North Dakota, Ohio, South Dakota, Tennessee, Vermont, Virginia, West Virginia. Our hope is to continue to expand into states that allow pharmacists to operate in this way. If you are a patient and do not reside in one of the above states, you are welcome to utilize the My Meds section but will be unable to participate in Quick Questions or Video Conferencing.)

* Zip:

* Phone Number:

Medical Conditions

Check all of the following medical conditions that apply to you:

Addison's Disease

Allergies

ALS (Lou Gehrig's Disease)

Alzheimer's Disease

Anemia

Anxiety

Arrhythmia

Arthritis

Asthma

Atherosclerosis

Back/Neck Injury

Bipolar Disorder

Blood Pressure Disorder

Cancer

Congestive Heart Failure

COPD (Chronic Obstructive Pulmonary Disease)

Coronary Artery Disease

Cough

Crohn's Disease

Cushing's Disease

Dementia

Depression

Diabetes Type 1

Diabetes Type 2

Dystonia (spasms/tremors)

Gastroesophageal Reflux (GERD)

Grave's Disease

Hashimoto's Thyroiditis

Hearing Problem

Heart Attack

High Cholesterol

HIV/AIDS

IBS (Irritable Bowel Syndrome)

Insomnia

Kidney/Bladder Disease

Liver Disease

Lupus

Migraines

Multiple Sclerosis

Obesity

Osteoporosis

Pain

Parkinson's Disease

Peripheral Artery Disease

PTSD (Post-traumatic Stress Disorder)

Restless Leg Syndrome

Rheumatoid Arthritis

Schizophrenia

Seizures

Shortness of Breath

Sleep Apnea

Stroke

Vision Problem

Weight Gain

Weight Loss

If you have any other conditions not listed above, please list them here:

Verification

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* By checking this box, you indicate that you have read and accepted the Terms of Use and Privacy Policy for this website.

Complete Registration