Sign Up for the Patient Portal
Let's get started. Fill out the information below.
1
Personal
Information
2
Confirmation
Please select all options that apply to you:
I'm a current or new patient at Bridge Patient Portal
*
I'm the legal caregiver of a current or new patient at Bridge Patient Portal
*
Legal First Name
*
Legal Last Name
*
Your Email Address
*
Password
*
Your password must contain
at least 1 number
at least 1 lowercase letter
at least 1 uppercase letter
at least 1 of the following characters:
!@#$%^&*()\-_=+{};:,<.>?|~
at least 8 characters in total
no more than two identical consecutive characters
Confirm Password
*
Your Date of Birth
*
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Male
*
Female
*
Security Question
*
What street did you live on in third grade?
What is your oldest sibling's middle name?
What was your childhood phone number including area code? (e.g., 000-000-0000)
What was the last name of your third grade teacher?
What is your maternal grandmother's maiden name?
In what city or town was your first job?
Security Answer
*
Add information for any children or dependents whose account you will manage.
Add Dependent
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