Please note:
If multiple members of your family are receiving service, each will have a unique username. If you
are requesting portal access for more than one individual, please fill out a separate form for each
person.
If you are requesting portal access on behalf of an individual that is 18 or older, we must have a
release of information consent form on file to grant access.
Upon completion of this form, you will be emailed an Invitation to the portal in 1-2 business
days. The link will be valid for 4 days. Please access the link to set up your username and
password.
