Register for Inpatient Portal Access

Please fill out the form below to register for the Middlesex Hospital online patient portal system.

You will receive an email within 72 Hours with a link to click on and verify/sign up for the Patient Portal account ( However, only patients who have had an inpatient stay (admitted for at least one overnight at Middlesex Hospital) on or after July 1, 2014 are eligible to register for at this time.

All fields are required unless otherwise noted.


First name is required.
Last name is required.
Date of birth must be a valid date.
Please indicate your gender.
Phone must be in 555-555-5555 format.
Please indicate if you have your MRN.
Please provide your MRN.
Address 1 is required
Address 2 is required
City is required
State is required
ZIP/Postal code is required
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