HIPAA-Compliant Email Address Request

To set up your own web-based personalized email, complete the information below and click "Send".

You can choose the name of your HIPAA-compliant email address below.

All addresses will be: [YOUR-CHOSEN-NAME]@HIPAA-doctorsinternet.com

We suggest using one of the following:

• [BUSINESS-NAME]@HIPAA-doctorsinternet.com
  (example: BrooklynDentalGroup@HIPAA-doctorsinternet.com)
• [FIRST-NAME.LAST-NAME.DEGREE]@HIPAA-doctorsinternet.com
  (example: john.smith.dds@HIPAA-doctorsinternet.com)

I would like my new HIPAA-compliant email address to be: