Please Note - At your annual Well Care visit you can request that your provider push a form to the My Health Connection Patient Portal. There is no charge for printing forms from your portal. 

1. Payment is required prior to receiving your form.
2. Regardless of the method you choose to request a form, pre payment will be collected prior to submission.
3. If after reviewing your form request, we determine that payment is not necessary, you will be refunded.
4. Please select your turn around time below.
5. Add your credit card information
6. Complete the Form Request Information including how you would like the form returned.
7. Once our Medical Records Department has reviewed and completed your form, they will email you with the encrypted form attached.
8. If you have elected to pick up your form, you will receive an email letting you know its ready for pick-up at our East Elizabeth Office.