HIGHTSTOWN MEDICAL ASSOCIATES

Email Signup Form


The New Email Registration System is up and running!

We are planning to begin using email to communicate with our patients on routine matters and for general practice information. If you are interested in being included, please complete the form below. Rest assured that sensitive, urgent or serious information will still be communicated directly by phone or in person.

In the form below, please fill in all fields. SUBMIT the form when complete.

You may enroll as many email addresses as you like, one at a time, but any email address will only be accepted once. If multiple family members share a single email address, then you need only enroll once for everyone.

To delete a name/email address, enter the first and last name and the email address to delete. A confirmation email will be sent to the to-be-deleted address requesting confirmation (by clicking a link in the email) before the actual deletion will take place.

To change a name attached to an email address, delete the old information and then enter the new.

An email will be sent to the registered address confirming additions. We will contact you if there are any problems with this enrollment. Thank you for joining our email list.

Please note: Because of the nature of the database change, email addresses submitted previously could not be converted. If you gave us your email address prior to April 1, 2006, please re-register.


Would you like to: Create an Email address or
Delete an Email address?
 
Your First Name:
Your Last Name:
Your Phone #:
Email Address:
Primary Physician: