Request Patient Portal Invitation

Use this form to request an invitation to our patient portal. Please use your most used email address.

I have read and agree to the disclaimer
Portal Request Disclaimer

Do not use this form to input personal health information. If you would prefer to request an invitation through the phone, please call us at 315-452-3235.

This message form is not intended as a tool for reporting a medical emergency or medical problem. It will not go to a physician and is only monitored during normal business hours. If you have critical or timely information, please contact a physician directly. If you have a medical emergency, please call 911.

315-410-7400
North Medical Plaza
5112 W Taft Rd, Suite E
Liverpool, NY 13088
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Monday – Friday
7:00 am – 3:30 pm
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