Need Help Enrolling in the SCH Hospital Patient Portal?
Fill out the form below and press "Submit." A member of the South County Health Patient Access team will contact you to enroll you in the South County Health Hospital Patient Portal within 2-3 business days.
Patient Full Name
*
First Name
Last Name
Contact Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address:
*
example@example.com
Date of Birth:
*
-
Month
-
Day
Year
MM/DD/YYYY
Cell Phone or Landline?
*
Cell Phone
Land Line
What do you need assistance with today? IMPORTANT NOTE: This form is only used for assistance with patient portal. If you have a question for your provider, prescription refill requests, or questions around your upcoming appointments, please call the office.
*
Please Select
I would like to enroll in the patient portal
I need a password reset
I don't know my user name
I have a question about my medical records
I would like to pay a bill
Can you tell us any additional details so that we can assist you?
*
Please verify that you are human
*
Submit
Should be Empty: