Physician Registration

Physician/Designee Portal Registration

Please select the best description of your relationship with Children's Health:

I am a licensed provider who refers patients and view clinical information

I am a registered nurse or non-clinical portal designee that needs to view clinical information

Personal Information

First Name

Middle Name

Last name

Degree

Gender Male Female

State of License

State License #

License Expiration Date

NPI #

Primary Specialty

Contact Information

Office Name

Office Phone

Office Address1

Office FAX

Office Address2

After Hours phone

Office City

Requester Email

Office State

Office Zip

Physician Designees Information

You may now designate personnel from your office to have view-only access to your patient list via the Children's Portal. To designate access to Children's Portal, complete the form by clicking the link to the right for your user(s). Re-authorization will be requested in 180 days to ensure your user(s) require access. Children's will initiate re-authorization.

Please Click here to Download Form to list your Designees.

Portal User Name and Password

Please allow us ten business days to verify your credentials and set up your account.
We will email your user name and password as soon as your credentials have been verified.
As a security measure, please provide us your answer to the questions below. If you forget your password, we will ask you these questions:

Date of Birth(MM/DD/YYYY)

Last 4 SSN

I accept the Terms and Conditions

Physician/Designee Portal Registration

Personal Information

Contact Information

Physician Designees Information

Supervising Physician Information

Portal User Name and Password