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[Required] Enter the name you use when logging into Appling Healthcare System Hospital Patient Portal.
[Required] Enter the e-mail address you associated with your account. Providing this information helps prevent unauthorized users from changing your password.
[Required] By entering these characters you help prevent unauthorized users from changing your password. Capitalization doesn't matter. Click on the refresh icon to get new characters if the current ones are too difficult to decipher.
[Required] Enter the answer you specified when you setup your account
[Required] Enter the answer you specified when you setup your account
[Required] Enter a password with which to secure your account. Capitalization matters. To make your password more secure, use special characters (e.g., @) and mix lower and uppercase. The password must be at least 8 characters long.
[Required] Retype your password to ensure it was entered as you expected.
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