Provider Portal Signup – Post Vasectomy Semen Analysis

Online Portal Access Confirmation/Sign up

In order to better serve you, we are pleased to partner with Sharefile to provide access to online results using Sharefile’s HIPAA compliant server system. You may continue to receive reports via fax, or you can opt in to the online portal by reviewing the stipulations below and signing the disclosure:

The Bedford Research Foundation PVSA lab is furnishing this information to you via a Sharefile HIPAA compliant server with additional security features. While every effort is made to keep patient data secure, by signing up for this service you acknowledge that information stored on this server is accessible via third party, and agree to hold the PVSA laboratory harmless in case of any data loss or breach that may occur.

Clinic portal access is available at pvsa.sharefile.com or by clicking the Provider Portal button on the PVSA.org website. If you have questions about the portal please call or email customer support at pvsa@bedfordresearch.org or 617-623-7447.

If signing up multiple providers, a new form should be submitted for each provider. Please refresh the form after submission, or click the “Submit and Enter New Provider” button at the bottom of the form.

Your PVSA Customer Service Team

Permission Agreement(Required)

I have read and understand the above statements and give my permission to set up the online portal using the email addresses on the following page.

I agree

Name

First Last Title

Practice Name(Required)

If single provider office, write “self”

Account #1 for this Provider

Name(Required)

First Last

Email(Required)

This will be the account’s username

Account #2 for this Provider (optional)

Name

First Last

This will be the account’s username

Account #3 for this Provider (optional)

Name

First Last

This will be the account’s username

Comments

This field is for validation purposes and should be left unchanged.