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[Required] Enter a username with at least 4 and no more than 32 characters. You may use letters, numbers, and the underscore character. This username will uniquely identify you on the Beth Israel Deaconess Hospital-Needham Patient Portal. Capitalization doesn't matter.
[Required] Enter a password with which to secure your account. Capitalization matters. To make your password more secure, use special characters (e.g., @) and mix lower and uppercase. The password must be at least 8 characters long.
[Required] Retype your password to ensure it was entered as you expected.
[Required] Enter the e-mail address you would like to associate with your account.
[Required] By entering these characters you help prevent fake registrations. Capitalization doesn't matter. Click on the refresh icon to get new characters if the current ones are too difficult to decipher.
[Required] By answering this math problem you help prevent fake registrations.
[Required] Select a security question from the list. This will be used in case you forget your username or password.
[Required] Make sure your answer is memorable to you but hard for others to guess. Capitalization doesn't matter.
[Required] Select a security question from the list. This will be used in case you forget your username or password.
[Required] Make sure your answer is memorable to you but hard for others to guess. Capitalization doesn't matter.
[Required] Enter the first name of the patient. If you are acting as the legal custodian for a patient (e.g., a parent for a minor child) and are signing up for the Beth Israel Deaconess Hospital-Needham Patient Portal to view that patient's medical information, enter the patient's first name, not yours. If you are signing up for the Beth Israel Deaconess Hospital-Needham Patient Portal to view your own medical information, enter your own first name.
[Required] Enter the last name of the patient. If you are acting as the legal custodian for a patient (e.g., a parent for a minor child) and are signing up for the Beth Israel Deaconess Hospital-Needham Patient Portal to view that patient's medical information, enter the patient's last name, not yours. If you are signing up for the Beth Israel Deaconess Hospital-Needham Patient Portal to view your own medical information, enter your own last name.
[Required] Enter the patient's date of birth. If you are acting as the legal custodian for a patient (e.g., a parent for a minor child) and are signing up for the Beth Israel Deaconess Hospital-Needham Patient Portal to view that patient's medical information, enter the patient's date of birth, not yours. If you are signing up for the Beth Israel Deaconess Hospital-Needham Patient Portal to view your own medical information, enter your own date of birth.
[Required] Enter the 16 character code given to you by the provider, 4 characters in each box. This code is used to securely link your account on the Beth Israel Deaconess Hospital-Needham Patient Portal to the provider's medical records for the patient.
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