Patient Portal Enrollment request Form
Established Patients - If you have not already received an email from email@example.com in the last 48 hours, please use this form to request enrollment in the Patient Portal.
- Once we receive your completed form and after validating your information, we will send you an email from (firstname.lastname@example.org) with instructions on how to complete your enrollment. Please click the link in the email as soon as you receive it, as it will expire in 30 days.
- Enrollment invitations are only sent to people 12 years of age or older.
- If your child is under 12 years of age, you can use this form to enroll them in the portal. If you are a parent/guardian of this child AND a Core patient, it is best to enroll yourself BEFORE requesting access to enroll your child. Please see our patient portal FAQ page for more information.
- Please allow up to 7 business days to receive your email enrollment invitation. If you need to reach your provider’s office sooner, please call them directly.
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.
Already Enrolled Patients - If you are already enrolled in the Core Physicians' Patient Portal, please do not complete this form. Instead, request assistance by completing our patient portal assistance form.