Registration is only required if you do not have a username. Please check your spam & junk mail folders to ensure you have not already received an email with a username and password. If you already have a username log in here

Each account must have a unique email address associated with it. Please contact us if you need multiple accounts with the same email address (i.e. related family members).

Client Information

/ Middle Initial

( optional )


( for Text Message Reminders )

Bill To Contact

/ Middle Initial

Emergency Contact

First Name
Last Name
Street Address
ZIP Code

Log in Details

( If client is a minor, the legal guardian must enter their email address below. )

Between 8 and 40 letters and numbers

Challenge Questions

( These will be used to retrieve your password. Answers must be between 4 and 30 characters, cannot contain any spaces. )

( If you feel you must write down your questions in order to remember them, make sure to keep it in a safe place. )

Terms and Policy

Provider Registration and Follow-up Consent
As a provider of mental healthcare services you are granting, Kurt LaRose, and the practice of Kurt LaRose (to be called "the practice" for the remainder of this consent) permission to communicate with you via this secure server, using secure email and other reminder based services, including text messages. If at anytime, you login to the server and schedule a video, chat, telephone, or office visit, you are granting the practice permission to send appointment reminders via text, using the cell phone number that you provide. Additionally, you are granting the practice permission to notify you by email (at the email address you provide) of appointment reminders, secure message notifications, files shared with you, and in some cases even invoices (note: invoices will show a zero balance if you have a FREE CONSULT PROMO CODE to discuss setting up your digital private practice).

Thank you for investigating, with a provider who has been in practice since 2005, how to move to an entirely paperless office, with 24 hour client side services, allowing you to have digital standardized assessment instruments, legal consents, insurance billing and credit card billing services! The practice is excited to have become an affiliate to the secure server professionals who have made this technology increasingly better week after week and year after since our initial use of this very platform in 2012!

Soon, you will see how your practice can be set up as a fully functioning, paperless, online marketed mental health provider (with video, chat, telephone and office sessions), with clients scheduling to see you (with all your intake forms and billing information pre-populated digitally and ready to review / use at the first session) online!  You'll spend less time in administrative tasks, and more time treating patients!  It is my experience, with the right web linking (healthgrades, psych. today, facebook, twitter, google, bing, yahoo, your domain - or a talkifuwant provider page included, plus your new digital server) that you'll likely see new clients, from the web, self scheduling - within a few weeks of 'going live.'

Please enter your promo code when prompted.  If you do not have a promo code please know you will be assessed a $99 fee for this practice set up consult, billed to a credit card when you schedule.  

DON'T HAVE A PROMO CODE?  Call 850-545-2886 and leave a message asking for a call back with a promo code before you schedule!

Intake Doc Rev: 11/3/17

( Type Full Name )