the-pediatric-center.com - Patient Portal Registration

Patient Portal Registration
Signing up to have access to the patient portal allows you to
do several things.
You will:
1. Have access to your child's medical records
2. Have the ability to print out visit summaries and other forms
3. Send your child's provider messages and questions
4. Request prescription refills (this is the required method)
5. You can also cancel a future appointment by message
Date

MonthDayYear
Date
Parent/Guardian Name:
Email Address :
example@example.com
Phone Number for the Account:
Please enter a valid phone number.

Please list all your children and their dates of birth below.

	Child's Name	Child's Date of Birth
1
2
3
4
5
6

Should be Empty: