Sign up for Samaritan Patient Portal

Thank you for your interest in joining the Samaritan Patient Portal. Please complete the below questions and then click the submit button. One of our Samaritan representatives will contact you. Please note if you make the request after business hours (8a-5p) or on the weekend, we will respond the next business day. Thanks.

Please enter your first name*
Please enter your last name*
Please enter your birthdate*
Please enter your email.*
Please enter your phone number.*
Please enter any other info that you feel is important.
Enter the text you see in the security image: