eBrainMD

	Become a patient

	Create a new patient account

	Secured log-in

	Cervical (neck)

	Lumbar (low-back)

		Lumbar Herniated Disc

	Thoracic (mid-back)

	Head injury

	Essential tremor

	Trigeminal neuralgia

	Hemifacial spasm

	Glossopharyngeal neuralgia

	Ulnar neuropathy

	Carpal tunnel syndrome

	Brain

Create a New Patient Account

Step 1

Please create an account by filling out the form below. You will then be directed to our New Patient forms to complete the initial process of becoming a patient of Dr. Clyde. Once an account has been created, you may save any unfinished forms and return to your account at anytime to complete them. After you have seen Dr. Clyde for an appointment, or had an online virtual consultation completed, you are considered an existing/established patient and will have access to other features of eBrainMD.com.

If you have any questions regarding any of our online forms, features, or use of this website, please call us at (801) 295-2438.

Patient Type:	In Office Consultation Virtual Consultation
First name*:	First Name is required.
Last name*:	Last Name is required.
Address*:	Address is required.
City*:	City is required.
State*:	State is required.
Zip*:	City and State will automatically populate. Please enter your zipcode. Zip Code is required.
Home Phone*:	Home Phone is required.
Email*:	Email is required.
Date of Birth*:	MM/DD/YYYY A valid date of birth is required.
Gender*:	Male Female


Username*:	Username is required.
Password*:	Password is required.
Confirm Password*:

Home | Terms of Use | Privacy Policy