Join MyPharmAssist

Join as a Pharmacist

Welcome to registration. This is where you create your online presence to help make that connection with patients. Fill out the fields below as you would like to appear online. MyPharmAssist.org does not edit your content, unless something doesn't fit with our brand like vulgar language or trying to use Tom Cruise as your profile picture, I don't think he was ever a licensed pharmacist. Either way, fill out the form below, submit the rental fee, and let MyPharmAssist.org work its magic. Within a few days, you will receive an email when your profile is completed.

Fill out the form below to join, fields marked with an asterisk (*) are required.

Your Information

Login Information

(Your email address will be used as your username for logging into the site. Please use a valid email address, as a verification will be sent to this email address to activate your account after registration.)
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(Please type a password between 12-16 characters that contains at least one capital letter, one number and one special character.)
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(Please retype the same password again.)
(Your hint will be emailed to you in case you forget your password - we will NEVER email your actual password.)

Address Information

(Quick Questions and Video Conferencing are able to operate in the following states: Arkansas, Iowa, Missouri, North Dakota, Ohio, South Dakota, Tennessee, Vermont, Virginia, West Virginia. Our hope is to continue to expand into states that allow pharmacists to operate in this way. If you are a patient and do not reside in one of the above states, you are welcome to utilize the My Meds section but will be unable to participate in Quick Questions or Video Conferencing.)

Background Information

(If you do not want us to use your name, please give a nickname we can use for identifying you on the website.)

Areas of Specialty

Check all of the following areas that apply to you:

Pharmacist Documents

(Covered entities are required to provide a Notice of Privacy Practices to their patients prior to service. If you do not have one, examples of Notice of Privacy Practices can be found at the HHS.gov website.)
(Additional licenses may be added to the system for a small fee and will require different email addresses for each state registered. Please submit an inquiry through the website once your initial registration is complete.)
(If there are additional legal documents that you would like patients to review and acknowledge before scheduling a video consult or asking a quick question, please upload those items as a single PDF or Word document)
(You must own the rights to this image.)

Verification