Medical Clinic CRM - Windows XP Edition

Medical Clinic CRM

Create a New Account

Register to access the Windows XP Medical Clinic CRM system

New User Registration

Username

Email

Password

Already have an account? Login here

Confirm

Are you sure?

Add New Patient

First Name

Last Name

Email

Phone

Date of Birth

Patient must be at least 18 years old.

Emergency Contact

Emergency Contact Relationship

Emergency Phone

Street Address

Apartment/Unit Number

City

State

ZIP Code

Preferred Contact Method

Notes