Patient Portal Activation Request
Complete the request form below.
The system will send you an automated invitation titled "Patient Portal Account Activation" from
noreply@nextgen.com
This can take up to 24 hours to arrive- but it is often much sooner.
First, you will setup one parent account.
Next, you will send a message through your parent account to request access to your children's accounts.
Do do this, use the "Send A Message" or "Ask a Question" features in the portal.
Include the First & Last Names & Date of Birth of each child.
You will receive access to their accounts within two hours, during business hours 8AM to 6PM.
Name of Parent
*
First Name
Last Name
Parent DOB
*
/
Month
/
Day
Year
Date
Parent Email
*
example@example.com
Parent Cell Phone
*
Please enter a valid phone number.
Which location is your family typically seen at?
*
Edina
Burnsville
Shakopee
Submit
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date field 1
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Month
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Day
Year
Date
date field 2
-
Month
-
Day
Year
Date
date field 3
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Month
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Day
Year
Date
Should be Empty: