Patient Portal Enrollment Form

Attention:

In order to have a patient portal account with CommWell Health, you will need to already be a patient at one of our CommWell Health locations. If you have never been seen at CommWell Health or have an appointment scheduled to be seen for the first time, please do not fill out this form. You may request access to your patient portal account after your first appointment/visit.

First Name *

Last Name *

Phone Number *

Email *

Date of Birth *

Address *

City *

State *

Zip Code *

Who will use this account? *

Are you requesting a new patient portal account? *

Please describe your request in detail *

Last Name

CommWell Health

1-877-935-5255 | Contact Us

6114 U.S. Hwy 301 S, Four Oaks, NC 27524

This link leads to the machine-readable files that are made available in response to the federal Transparency in Coverage Rule and includes negotiated service rates and out-of-network allowed amounts between health plans and healthcare providers. The machine-readable files are formatted to allow researchers, regulators, and application developers to more easily access and analyze data.

CommWell Health Has Earned the Joint
Commission’s Gold Seal of Approval and Primary
Care Medical Home Certification
(Certified Patient-Centered Medical Home)

Manage your health online, anytime. You can connect with your health care team through a convenient, safe, and secure environment.

Already signed up? Click here.

To enroll in the patient portal click here.

Patient Portal Enrollment Form

Manage your health online, anytime.
You can connect with your health care team
through a convenient, safe, and secure environment.