Welcome to GTI PatientPower Quick Registration Plus
To sign up for MyMedicalFolder, simply fill out the required fields below, enter any relevant medical information, and press the "REGISTER NOW" button at the bottom of this page. You will be assigned a username and password that you can then use to start editing your medical information in your personal area. All the medical information that you enter on this page will automatically appear in your MyMedicalFolder file.

If you do not have the time to enter any medical information and would still like to register for MyMedical folder, click here to enter your contact information and get a username and password.

Be sure to write down or print out your username and password when they are displayed later. And please remember that the Username and password are case sensitive, so write them down accurately and enter them into the login form exactly as they appear.

Contact Information
Bold Fields are required for registration
First Name
Middle Name
Last Name
Home Address1
Home Address2
City
State
Zipcode
Daytime Phone ### ### - ####
Evening Phone ### ### - ####
Email Address (see note below)
Note: Although a valid email address is not required, if you forget your password, a valid email address is needed to reissue it instantly. If you have a valid email address now, please enter it to ensure that you can retrieve your password easily if needed. If you do not have a valid email account now, one can be entered later from your MyMedicalFolder page.

Background Information
Date of Birth (mm/dd/yyyy)
Emergency Contact Relationship to Emergency Contact
Emergency Contact Daytime Phone ### ### - #### Emergency Contact Evening Phone ### ### - ####
Primary Care Doctor Primary Doctor Phone ### ### - ####
Specialist Name Specialist Phone ### ### - ####
Primary Insurance Name Primary Insurance Phone ### ### - ####
Secondary Insurance Name Secondary Insurance Phone ### ### - ####
Social Security Number ### - ## - #### Gender
Number of Children Marital Status
Occupation Blood Type
Caffeine Smoking

Personal and Family History
Exercise
Diet
Allergies/Drug Reactions
Previous and Resolved Illnesses
Mother
Father
Other

Conditions

Condition 1
Date (mm/dd/yyyy)
Description
Doctor
Hospitalization or Surgery?

Condition 2
Date (mm/dd/yyyy)
Description
Doctor
Hospitalization or Surgery?

Condition 3
Date (mm/dd/yyyy)
Description
Doctor
Hospitalization or Surgery?

Condition 4
Date (mm/dd/yyyy)
Description
Doctor
Hospitalization or Surgery?

Condition 5
Date (mm/dd/yyyy)
Description
Doctor
Hospitalization or Surgery?

Drug Information
Drugs Name Class Start Date (mm/dd/yyyy) End Date (mm/dd/yyyy) Dose How Often
Drug 1
Drug 2
Drug 3
Drug 4
Drug 5

Procedures
Procedures Date Performed (mm/dd/yyyy) Type Result Location
Procedure 1
Procedure 2
Procedure 3
Procedure 4
Procedure 5

Important
We at GTI thank you for your participation in our PatientPower Beta Test program. Please use PatientPower to its full capability and send corrections, feedback, and suggestions to betasupport@gtipatientpower.com.
"My Medical Folder" © Global TeleImaging, LLC