Mybothwellhealth.brhc.orgtemplatesselfsignupCreate an account: Welcome To Your Patient Portal 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your personal information in the designated fields, including your name, date of birth, phone number, address, and email address.
3. Indicate whether you are 13 years or older by selecting 'YES' or 'NO'. This is important for compliance with privacy regulations.
4. If you wish to authorize a proxy to access your patient portal, fill in their details such as name, date of birth, phone number, address, and email address. Ensure both you and your proxy sign the authorization section.
5. Review the authorization statement carefully. By signing it, you grant your proxy access to view your health information through the portal.
6. If you choose to decline enrollment in the patient portal at this time, check the appropriate box provided.
7. Finally, ensure all signatures are completed where required and submit the form as instructed.

Start using our platform today for free and take control of your health information!