Patient Portal

Register with Inspired Health (+ Glow) - The Clinic of Drs Weintrob and Dishman

Welcome to the Inspired Health REGISTRATION PAGE!

To register as a new patient, please enter your information in the form fields below.

Please do not use this form if you are already a patient (you have seen any of our practitioners in the past).

To set up patient portal access or amend your information, please contact us.

If you are already a registered patient with online access, you can log in here.

We ask that all NEW Patients REGISTER to schedule an initial appointment.

The Registration will allow you to create a username and password for your Patient Portal.

Once you have logged into your Patient Portal, we require the following forms be filled out in order to schedule:

  • All of the mandatory NEW PATIENT INTAKE FORMS located in the Questionnaires Tab
  • Update a Credit Card on file to hold your appointment.

When your Intake forms are finalized, our office will contact you to set up an initial appointment!!

Prior to your initial appointment, we encourage you to look around our website, visit our Online Store, and to read up on how we work with patients.

We are honored that you’ve chosen us to partner on your journey towards Inspired Health.

Basic Contact Information

Your Address

Contact Information

Emergency Contact

Insurance Information

Our office will bill your insurance(s) as a courtesy. In-Network Insurance Companies are listed HERE
Please remember that outstanding balances not paid or delayed by insurance processing are patient responsibility and due within 60 days from date of service. We also expect patient responsibility to be paid at the time of the visit (deductible, coinsurance, copay).
If you plan on using Insurance, please fill out all mandatory fields:

Medical Information

Please enter your basic medical information below. You may also add or edit this information after you've signed up.

Set Username and Password for Patient Portal

Please create a username and password that you will use to log into the patient portal in the future.

Your username must be at least 4 characters long

Your password must be at least 8 characters long and include at least one number or special character.

The patient portal gives you access to your medical records and lets you securely communicate with your doctors. When you sign up, you will receive an email with instructions for logging in.

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