Sign Up

There were some errors found in the form. Fix these errors and submit again.

Patient Information

Please follow the steps to set up your user ID, password and security questions to complete your activation. If you have any questions, please contact the MyBellinHealth help desk by calling 888-899-9114.

Indicates a required field
Your privacy is important to us, so we do not require a full social security number. However we will ask you a few questions to confirm your identity.

Follow these steps to sign up for a MyBellinHealth account.

Enter your personal information.
Verify your contact information.
Choose a username and password.

If you have any questions, please contact us at 877-259-6180.

Follow these steps to sign up for a MyBellinHealth account.

Enter your personal information.
Verify your identity.
Choose a username and password.

If you have any questions, please contact us at 877-259-6180.

Once verified, please follow the steps to set up your user ID, password and security questions to complete your activation. If you have any questions, please contact the MyBellinHealth help desk by calling 888-899-9114.

Indicates a required field
Your privacy is important to us, so we do not require a full social security number. However we will ask you a few questions to confirm your identity.

Indicates a required field.

Error: We are experiencing technical difficulties at this time. Please try again.

Name

First name

Middle name

Last name

Address

Other Information

Date of birth

Legal sex

FemaleMaleUnknownOther

Last four digits of SSN

Email address

Verify email address

Home phone

Mobile phone

Thank you - your request has been sent to the clinic. You will receive an activation code in your mail or email within a week.

If you have any questions or if you do not receive your activation code, call customer service.

Back to Login Page

We were unable to verify your information, so your request has been sent to the clinic. You will receive an activation code by mail or email within a week.

If you have any questions or if you do not receive your activation code, call customer service at 877-259-6180.

Back to Login Page

We are experiencing technical difficulties at this time. Please try again later or contact our customer service line for assistance.

Back to Login Page

We were unable to verify your identity using the information provided. Please contact customer service at 877-259-6180 for assistance.

Back to Login Page

We are experiencing technical difficulties at this time. Please contact our customer service line for assistance.

Back to Login Page

There is an existing account for this person.

From the login page, click "Forgot username?" or "Forgot password?" to access this account.

Back to Login Page

There is an existing account for this person.

Please contact us directly to restore access to your account.

Back to Login Page

We are experiencing technical difficulties at this time. Please try again or contact our customer service line for assistance.

Unable to complete MyBellinHealth signup. Please contact customer service at 877-259-6180 for help activating your account.

Back to Login Page

In order to grant you a MyBellinHealth account, we will verify your identity using questions from a third-party verification system. Once verified, you will be able to create your MyBellinHealth account. If you have any questions, please contact your clinic.

We are checking with a third-party system to verify your identity. This may take several seconds.

Unable to Verify Your Identity

We are unable to verify your identity using the information provided. Please contact our customer service line for assistance.

Back to Login Page

Unable to Verify Your Identity

We are experiencing some technical difficulties while communicating with the third-party verification system. Please contact our customer service line for assistance.

Back to Login Page

These questions are generated by a third-party system to verify your identity.

You may be redirected after a few seconds.