myRBMC Patient Portal Request

  This form is intended solely to allow activation code requests for the myRBMC Patient Portal. If you have symptoms of an urgent nature, please call your doctor or go to the nearest
  emergency room immediately.

  To request your activation code for myRBMC Patient Portal, please fill out all fields below. An myRBMC Patient Portal activation code is required to create your online health account.

  Who Is Eligible?

  myRBMC Patient Portal is available to newly scheduled and current hospital patients 18 years of age or older.

  Already have an Account?

  Please go directly to the login page and sign in.

 *Have you had services performed at Raritan Bay Medical Center?
 If you have ProxyCode enter it here:
*First Name:
*Last Name:
*Date of Birth:
*Social Security Number (last 4 digits only):
Patient Account Number:
*Email Address:
Address Line 1:
Address Line 2:
Zip/Postal Code:
Home Phone (i.e. 2155551234, no dashes):
Mobile Phone (i.e. 2155551234, no dashes):

Your activation code will be sent to you after the request is validated. If there are any questions regarding your submission, you will be contacted via the phone number submitted.