Use this form to request a CMH Patient Portal account. Please fill out the form as completely as possible. If you do not know your Clinic Account Number or Medical Record Number, leave the field blank and a CMH representative will contact you to complete your portal registration. Once you have been registered for the CMH Patient Portal, you will receive an email from email@example.com with instructions to complete your account registration.
Proxy access must be requested in person at a CMH Clinic. The patient granting proxy access to their account must present picture identification in accordance with HIPAA regulations.