Register

Register Your Clinic!

This form is simply to register an account with Physio Roots. After your account is registered, you can then claim or add your clinic.

You'll be redirected to setup your clinic immediately after registering.

Clinic name*
Account holder name*
First Last
Clinic Address*
Street Address Address Line 2 City Province Postal Code
Clinic phone*
Alternative phone (ie. account holder phone)
Email*
Enter Email Confirm Email

This can be different than the clinic email. This email is used for communication between Physio Roots and the account holder.
Username (used for logging into your account)*
Password*
Enter Password Confirm Password

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Privacy Policy*
I have read and agree to the website privacy policy.
Terms of Service*
I read and agree to the website terms of service.
<div style="font-size: 14px">I consent to receive email updates (recommended, and you can opt out at any time)</div>
Physio Roots is constantly changing along with the information you can attach to your clinic. Updates could be about anything from new skills and services, to brand new account features. Email updates may also include terms of use and privacy policy updates, as well as website promotions.
Select this if you would like to receive email updates to keep in the loop! Emails occur fairly infrequently and you can opt out at any time.
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