12 yrs – 17 yrs

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Portal invitation request for parents of children:

Because of legal and privacy concerns, if a portal is initiated, patients decide if they or their parents (or both) have access. Please speak to your children and ask if they will allow you to manage their online account as a Proxy or if they would prefer to manage it under their own email/password.

If a patient manages her or his own account, he or she can grant access through the portal to others (and vice versa)

Person Managing Account:

 

  • Parent/Guardian will manage
  • Patient will manage
Parent Information:
First Name*
Last Name*
Telephone*
Email*
Address*
Children Information (If Parent/Guardian managing):
Name*
DOB
(mm/dd/yyyy)
*
Name
DOB
(mm/dd/yyyy)
Name
DOB
(mm/dd/yyyy)
Name
DOB
(mm/dd/yyyy)

 

You will receive an email invitation to join the portal within a short period of time.