HealthVault
By completing this form, you are allowing CMH to send and receive medical record information to and from your Microsoft HealthVault Account.

First Name:

Last Name:

Social Security Number:
A value is required.Invalid format.
Date of Birth:
A value is required.Invalid format.
Email:
A value is required.Invalid format.
Security Question:
Security Answer:
CMH Account Number:
Are you a Google Health user?
No
Requested Portal Username:
Your request will be processed within 2 business days. A CMH staff member may contact you to verify your information if you did not provide your account number.