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Registration:

Thank you for using Garden City Pediatric's online services.  

After we receive this information, please allow us some time to look it over and make sure it is correct.  We will then register your account and notify you by email and you can then begin using our online services to schedule appointments, request records and refill your prescriptions.

Registration

Please complete the following:

About You (parent / guardian):

Your First Name:
Your Last Name:
Choose a password:
Enter your password again for verification:  
Your Address:
Street:
City:  State: 
Zip:  
Email:  
 
Your Phone Number:
Home: -
Work: -
Cellphone:

About Your Child:

Child's name:
First Name:
Last Name:
Child's Date of Birth: Month:     Day:    Year:
     

Child's Insurance:
Insurer Name:
Subscriber ID:
 
Child's Primary Care Provider:     

Note: You can add more children to your profile after you register.


  GCP    

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