8160 Seaton Place ▪ Montgomery, Alabama 36116 ▪ (334) 272-1799 ▪ Fax: (334) 272-4876 136 East Main Street ▪ Prattville, Alabama 36067
Please correct the errors described below.
PATIENT PORTAL RELEASE
Our Patient Portal offers you a convenient, anytime access to patient health information
and puts YOU at the center of your healthcare. With the ability to view accurate health
records, lab results, and communicate with your doctor, you are helping us to expand and
improve your health care experience!
Always dial 911 for emergency situations. DO NOT leave a message on the Patient
Portal as it could take 24-48 hours for a response.
I further acknowledge:
I have been given my portal login information.
I understand it is my responsibility to maintain the confidentiality of the information
contained in the documents.
I understand the patient portal should NOT be used for emergency situations.
I understand messages will not be addressed if received from any individual who is not
currently authorized on my Registration Form to obtain such information according to
HIPAA patient health information (PHI) privacy rules.
Your information will be encrypted.
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