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Medical Passport Account

First, create a Medical Passport account so you can sign in and access or update your information at any time. Once completed you can provide a copy to any healthcare facility you choose.

Patient Information
  5. Sex (please choose sex at birth)
Patient Address
  1. Does the family member have the same address as you?
Contact Numbers
  1. Please enter at least one phone number below.
    (never shared, only used for confirmations and support)
  9. Can the healthcare team and its affiliates send the patient important healthcare and financial messages via text? (The patient may opt out at any time by texting STOP)
{{ompServerVars.isNewPatient == 1 && !sv.IsFacility ? 'Create a Secure Sign In' : 'Security'}}
  1. * Username not available
  2. {{form.Username}}
  1. Change password
  8. Add an extra layer of security to your Medical Passport account by enabling two-factor authentication - an optional but highly recommended feature. Once enabled, you will be required to enter a code sent via text message (SMS) to your mobile phone or emailed to you.
    • Text Message (SMS) codes will be sent to your mobile phone {{TwoFactorMobilePhone}}
    • Text Message (SMS) codes will be sent to your home phone if it is a mobile number {{TwoFactorHomePhone}}
    • Email codes will be sent to your email address {{TwoFactorEmail}}
  10. Terms of Service.
  12. Your information is never shared with anyone other than your healthcare team. See our Privacy Policy.
Save & Continue
You'll have a chance to update information. Each section must be completed, but you will be able to make changes before you finish.
Your Medical Passport account is set up! We recommend completing your medical history on a tablet or desktop computer. Once you finish it will be sent to the surgery center. <span id="mayweremind" style="display:none;">May we send you a reminder email to log into your account and finish later?</span>

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