Registration Request for PatientSite
- Do not re-register if you have forgotten your username/password. Click
to request username/password assistance.
- To register for PatientSite, your are required to
be at least 18 years of age
have had an appointment with a PatientSite clinician
1. Choose a clinician who currently provides care to you
Provider first name:
Provider last name:
2. Enter your demographic information exactly as it appears on your insurance card
Date of birth (mm/dd/yyyy)
Last 4 SSN
Daytime/cell phone number
3. Choose your secret question and answer
(You will be asked to supply your answer if you forget your username and/or password.)
Select a question
What is your mother's maiden name?
What city were you born in?
What is your father's middle name?
What kind of animal was your first pet?
What was the name of your first pet?