Patient Portal Adult (18+) Invitation Request

Please fill out the form below to receive an invite to join our new patient portal.

THIS FORM IS FOR PATIENTS 18 YEARS AND OLDER 

If you are the parent of a patient under the age of 18, please click here to request an invitation for access to your child's health record. 

First Name
Last Name
Date of Birth
Email Address

OPTIONAL

I would like to give access to my online medical records via Follow My Health to the following parent/guardian:
Name
Email Address
Relationship to Patient(s)
Patient Signature
(full name)
Today's Date

**You will receive an email within a few days from noreply@followmyhealth.com that will
include an invitation link, and instructions to help walk you through the registration process.

** The security code will be your year of birth (XXXX).

**Follow My Health is compliant under all HIPAA regulations.