Online Dispensary Registration

Register for Dr Leah Hechtman’s online patient dispensary.
Note: You must be an existing clinic patient to be accepted.

Name(Required)

First Last

Email(Required)

This email address will be used as your login for the Online Dispensary

Phone(Required)

Date of Birth(Required)

Delivery Address(Required)

Street Address City State Post Code Country

Delivery Notes

Password(Required)

Enter Password Confirm Password

Strength indicator

Please set a password for your online dispensary account.

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