Patient / Parent Registration

Create your account

Fill out the details below to get started with Brainworks.

1 Parent / Guardian Information

First Name*

Last Name*

Email Address (For OTP Verification)*

Contact Number*

Relationship*

Home Address*

2 Patient Information

First Name*

M.I.

Last Name*

Gender*

Date of Birth*

Preferred Therapy Service*

Diagnosis / Medical Condition*

Auto-Assignment The system automatically matched you with an available specialized pediatrician.

3 Account Information

Username*

New Password*

• 8–16 Characters

• Uppercase & Lowercase

• Number & Symbol

Confirm Password*

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