Patient Portal Enrollment Form

1-877 WELL ALL
1-877-935-5255
Contact Us

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Portal Enrollment Request 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.

Name*

Email*

Phone*

Date of Birth*

Address*

Who will use this account?*

Patient

Patient's family member

Are you requesting a new patient portal account?*

Yes

Please describe your request in detail*

CommWell Health

1-877-935-5255 | Contact Us

3331 Easy Street Dunn, NC 28366

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.

Portal Enrollment Request Form

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