Account

Create an Account

Please submit the required fields below.

Contact Information

Legal First Name

Middle Initial

Legal Last Name

Suffix

Gender

Male Female

Date of Birth

Phone Number

Email Address

Address

Apartment, Suite, Unit, Building, Floor, Etc. (Optional)

City

State

Zip

Username

Password

Note: Must contain uppercase, lowercase, one number and one special character

Confirm Password

Would you like to access your UH medical records?

Note: You will have access to your appointment history, cancellations, reschedules, etc.

Yes No

Use Verified Address

Use Original Address