Core AT

Patient Self Registration

Personal Details

The CORE-AT Electronic Medical Record (EMR) is the documentation system that your athletic trainer uses to record injuries, treatments, and other health information. Please follow the instructions below to create your account.

Please select your school:

Please enter the required information below to create your acount. Note that all fields marked with an * are required.

First Name:

Initial:

Last Name:

Preferred Name:

Pronouns:

Please create a user name that is easy for you to remember. Consider using the first initial of your first name and your full last name. For example, if your name is John Doe = jdoe. If your user name is not available, try adding a number like your jersey number to the end of the user name = jdoe18.

Please create a password that is easy for you to remember but hard for someone to guess. Your password should be at least 4 characters long. Passwords are case sensitive.

Patient Username:

Password:

Retype Password:

Email:

Send Email Notifications

Primary Activity Category:

Sex Assigned at Birth:

Current Gender Identity:

Graduation Year:

Birthday:

Height (in):

Weight (lbs):

Declared Disability:

Race:

(select all that apply)

American Indian/Alaska Native

Asian

Black of African American

Native Hawaiian/Pacific Islander

White

Prefer not to respond

Ethnicity:

Hispanic, Latino, or Spanish Origin

Not Hispanic, Latino, or Spanish Origin

Prefer not to respond

Address:

City:

State:

Zip:

Home Phone:

Work Phone:

Cell Phone (for account verification):

Please list out any known medical conditions (e.g., asthma, high blood pressure, sickle cell trait, etc. ) If none, enter "n/a":

Guardian #1

First Name:

Initial:

Last Name:

Address:

City:

State:

Zip:

Home Phone:

Work Phone:

Cell Phone:

Relationship:

Secondary Guardian or Emergency Contact

First Name:

Initial:

Last Name:

Address:

City:

State:

Zip:

Home Phone:

Work Phone:

Cell Phone:

Relationship:

Primary Care Physician

First Name:

Initial:

Last Name:

Address:

City:

State:

Zip:

Phone:

Learn more about A.T. Still University
Visit the AT-PBRN