Patient Portal (MEDFUSION) Enrollment Form

If you are already enrolled and need help with your username or password, please go to the login page and click the I forgot my user name and/or password link.

Established patients of Core Physicians can use this form to request enrollment in the new Patient Portal (Medfusion).

Once we receive your completed form and after validating your information, we will send you an email (from noreply@medfusion.net) with instructions on how to complete your enrollment. Please click the link in the email as soon as you receive it, as it will expire in 30 days.
Enrollment invitations are only sent to people 12 years of age or older.
If your child is under 12 years of age, you can use this form to enroll them in the portal. If you are a parent/guardian of this child AND a Core patient, it is best to enroll yourself BEFORE requesting access to enroll your child. Please see our patient portal FAQ page for more information.
Please allow up to 10 business days to receive your email enrollment invitation. If you need to reach your provider’s office sooner, please call their office directly.

New patients please reach out directly to your provider’s office to register in our system. At that time you will receive a patient portal enrollment email invitation.

Adult or Adolescent Patient (12+)

First Name:
Middle Name:
Last Name:
Date of Birth:
Street Address:
City/Town:
State:
Zip Code:
Personal Phone #:
Personal Email Address:
Confirm Personal Email Address:
	I certify the personal email address provided is that of the above person

To request the addition of a dependent (child under 12) to your patient portal account

You must be the parent or legal guardian of the child/children listed below. Once a child turns 12, access will expire. If you are also a Core patient, it is best to enroll yourself first BEFORE requesting access to enroll your child.

I certify that I am the parent or legal guardian of the child/children (dependents) listed below.