Amberwell Patient Portal Request

Amberwell Patient Portal Request
How can we help you today?

I need to enroll for the first time.I cannot remember the email address I used or my login ID.I need help using the portal.
If you need help using any of the features within the portal, please login and use the support feature within the myAMberwellhealth portal itself, as this is the best way to ensure your specific questions can be addressed.

Patient Enrollment

Please submit a form for each patient.
Patient Name*

First NameLast Name
Patient age*
Under Kansas law, minors have the right to privacy for certain personal health information. We are in the process of enabling login to the myAmberwellhealth patient portal account directly by a minor who can then share access with their parent. Until then, health records for minors over the age of 12 are only available via fax, email, or print directly from our HIM department.

For assistance with these requests, please use the following information:

For care at Amberwell Hiawatha or Amberwell Highland Clinic, call 785-742-6180.
For all other care locations, call 913-360-5507
Your Name*

First NameLast Name
Patient Date of Birth*

MonthDayYear
MM-DD-YYYY
Email*

Confirmation Emailexample@example.com
Phone Number*
Please enter a valid phone number.
Last 4 Digits of Patient SSN*
Locations of Care*

Amberwell AtchisonAmberwell Eighth Street ClinicAmberwell HiawathaAmberwell Highland ClinicAmberwell Horton ClinicAmberwell Leavenworth ClinicAmberwell Troy ClinicOther
AH Hiawatha Enroll
AH Atchison Enroll
Should be Empty:

Login Support