Client Portal Registration Request

Client Portal Registration Request

If you would like to access the Thrive Client Portal, please fill out this registration request. A registration code will be sent to your email within 24 business hours. If you need faster access to the portal, please call the office between the hours of 9am and 5pm at 410-780-5203
If you have previously registered for the portal and have a username and password, please log in here: Client Portal
Name of Person Requesting Access

First NameLast Name
Birthdate of Person Requesting Access

MonthDayYear
Date
Email of Person Requesting Access
example@example.com
Phone Number of Person Requesting Access
Please enter a valid phone number.Format: (000) 000-0000.
Are you the client?
Name of individual receiving services from Thrive Behavioral Health:**Enter "Self" if you are requesting access for yourself.
Client's Name

First NameLast Name
Client's Date of Brith

MonthDayYear
Date
Relationship to Individual Receiving Services from Thrive
If other, please specify:
Do you have legal authority to access this client’s treatment information and client portal?
Portal access can only be granted to individuals with legal authorization. Our team may contact you for clarification.
Relation to individual receiving services from Thrive Behavioral Health:**Enter "Self" if you are requesting access for yourself.
Photo ID for the Person Requesting Access

Cancelof
Have you previously provided guardianship paperwork?
Proof of Guardianship (Birth certificate or Court Order). This is needed for access to the chart.

Cancelof
Should be Empty: