Patient Portal (NextMD) Enrollment Form

New and established patients of Core Physicians can use this form to request enrollment in the Patient Portal (NextMD).

Once we receive your completed form and after validating your information, we will notify you of your temporary enrollment token number. You will also receive an email with instructions on how to use this token number to complete your patient portal enrollment.

Enrollment token numbers are only offered to adults 18 years of age or older. For further assistance, please call 603-580-6753.

Adult Patient/Enrollee

How would you like to receive your patient portal enrollment token number?

To request the addition of a dependent (child) 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. Partial access can be granted for children ages 12-17. Once a child turns 18 all access will expire.