myGeisinger Account Request Form

Please complete this form if you meet any of the following categories:

  • You have not been cared for at Geisinger before
  • You don’t have Geisinger Health Plan insurance (and never have had Geisinger Health Plan insurance)
  • You don’t have a medical record at Geisinger

Once this form is completed, a Geisinger representative will create a medical record for you and send you information to register for a myGeisinger account.

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