Join the AMII Platform

Patient Registration

Create an AMII patient account to request consultations, review reservations, receive offers, and follow your treatment journey.

Create your Patient account

Complete the required account fields. Documents can be added now or later.

This account will be registered with the Patient application role.

Account information

First name

Last name

Phone number

Password

Confirm password

Profile picture Optional. JPG, PNG, or WEBP. Maximum 3 MB.

Home address

Optional. This is also copied into the existing primary-address fields used by earlier application workflows.

Street address

City

State

ZIP code

Work address

Optional.

Street address

City

State

ZIP code

Insurance

Optional. Select No Insurance or leave this section blank to complete it later.

I do not currently have dental insurance

Insurance provider

Policy number

Group number

Member ID

Subscriber name

Relationship to subscriber

Expiration date

Insurance card front Optional. Maximum 5 MB.

Insurance card back Optional. Maximum 5 MB.

Identification

Optional. Leave blank to upload identification later in the patient application.

Document type

Document number

Issuing state

Issuing country

Name on document

Expiration date

ID front Optional. Maximum 5 MB.

ID back Optional. Maximum 5 MB.

Already have an account? Return to login