Below is a sample of the emails you can expect to receive when signed up to Middlesex Health.
Patient Portal Registration Request
Name Joshua Clark Date of Birth 05/05/1997 Gender Male Phone Number 555-654-6589 x87987 Email Address @ Medical Record Number (MRN) Clark Address Not provided
Data Name | Data Type | Options |
---|---|---|
First name | Text Box | |
Last name | Text Box | |
Text Box | ||
Home address | Text Box | |
City | Text Box | |
State | Text Box | |
Zipcode | Text Box | |
Gender | Text Box | |
Gender | dropdown | Select one … |
Phone | tel | |
Do You Have Your Medical Record Number? | dropdown | Select one … |