External Provider User Registration - MyPatients at Boston Children's

	Contact Us FAQ\|

User Registration

*indicates a required field

First Name*
Last Name*
Date of Birth*
Email Address*
Confirm Email Address*
Provider Type*
Provider NPI*
Specialty
Practice Name*
Practice Address*
Practice Address*
City*
State*
Zip Code*
Country*
Phone Number*	--
Fax Number	--
Request Sponsorship Privileges?
	Please review the registration form; the information you submit will be sent to our registration team.
	Submit Clear

If you have any questions about the MyPatients registration process, please send an email tomypatientsprovisioning@childrens.
harvard.edu