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User Registration

Complete this form to create a new patient portal account.
  • If you need access to another person's record, click here for parental access and here for access if the patient is 18 years or older.
  • Patients 18 or older can register themselves.
  • Our system uses your legal name, e.g. Robert, not Bob. If you entered the correct name and still can’t access the portal, fill out this form. We’ll send information to create your portal account. This may take up to 3 business days.

Identify Yourself

Asterisk (*) denotes a required field First Name*: Middle Initial: Last Name*: Suffix: Date of Birth*:
Zip Code*:
If you currently reside at a temporary location, please use the zip code of your permanent address.
Last four digits of Social Security Number ### - ## -  Please select your primary organization*: Have you been seen at your selected primary organization in the past?* Yes No Medical Record Number (Optional):
You can obtain your patient medical record number from the Geisinger Health Plan billing statement received in the mail.
Other ways to obtain your medical record number include:
- Your patient after visit summary, which is given to you at the end of each doctor's office visit.
- Your appointment notices, which you receive by mail.
- Your Geisinger Health Plan insurance card.
- By calling the Patient Services Call Center at 1-800-640-4206.