Request Access to Patient Portal

Use of this patient portal and your authorization to enter information into the portal system, is completely voluntary. The portal will NOT contain your full medical record.



For information about what specifically is included in the MyLifeBridge Health patient portal please refer to the FAQs at:

(https://www.lifebridgehealth.org/Main/PatientPortalFAQ.aspx)



This form is to be used for requesting a Patient Portal account for yourself as the patient. Request for proxy access to your or another patient’s Patient Portal is not available remotely. This form is also not to be used for patients who are under the age of 18. Remote requests for pediatric patients is not available.



Once you have successfully completed and submitted the information below, you will receive an email “invite” to the Patient Portal within 1 business day. Please follow the instructions in the email “invite” to proceed to “claiming” your account and setting up a new user name/password for subsequent use. You will not be able to log into the Patient Portal unless you first “claim” your account from the email “invite”.



If you do not receive your Patient Portal email “invite” within 1 Business day, please check your “spam” or junkmail before calling our Call Center support at 410-601-9355 for further assistance if necessary.

To successfully submit your Patient Portal request, you must complete each of the following steps:

Please ensure that ALL fields are filled out completely and accurately.

Step 1: Select one of the options below

Is this a resubmission of a previous Portal Request?*
Do you already have a Portal Account (already signed up)?*
Relationship to Patient*

For Pediatric and Adolescent patients only.

Step 2: Please complete the following questions:

LifeBridge Relationship*

Please enter the last 4 digits of you Social Security Number. Please include leading zeros if necessary. This is necessary for account validation and creation.

Last 4 digit of requestor's SSN
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Please enter the last 4 digits of you Social Security Number. Please include leading zeros if necessary. This is necessary for account validation and creation.

.

Phone

A valid email address is required for Portal account.

A valid email address is required for Portal account.

Please enter the last 4 digits of the patient's Social Security Number. This is required to assure stated relationship.

Step 3: Please read and acknowledge by placing a check mark in each box

(You will NOT be able to submit your request unless you do so)

Please Note; All Covid Results will be posted on the Portal. No results will be given by phone.

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