Hightstown Medical Associates
Email Sign-up Form

We plan to use 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. You may change or delete your email address from our database at any time. Rest assured that sensitive, urgent or serious information will still be communicated directly by phone or in person. This is a work in progress; the use we make of these email addresses will likely change over time. However, you have our absolute assurance that we will never sell, share, or divulge your email address to anyone and will not use it for any purpose other than that stated above.

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. 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.

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.

In the form below, all fields are required. SUBMIT the form when complete.

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: