Patient Portal (MEDFUSION) Enrollment Form

Established patients of Core Physicians can use this form to request enrollment in the new Patient Portal (Medfusion).

Once we receive your completed form and after validating your information, we will send you an email (from with instructions on how to complete your enrollment.

Please allow up to 10 business days to receive your email enrollment invitation. If you need to reach your provider’s office sooner, please call their office directly.  Please do not submit more than one entry per patient. Submitting multiple requests for the same patient delays the process for you and everyone else.

Enrollment invitations are only sent to people 12 years of age or older. If your child is an established patient under 12 years of age, you can use this form to enroll them in the portal. Please see our patient portal FAQ page for more information.

New patients please reach out directly to your provider’s office to register in our system. At that time you will receive a patient portal enrollment email invitation.

Adult or Adolescent Patient (12+)

To request the addition of a dependent (child under 12) to your patient portal account

You must be the parent or legal guardian of the child/children listed below. Once a child turns 12, access will expire.