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Patient Portal Account
If you are unable to access Patient Portal or you would like to request your login information, please fill out the information below. The email provided within this form will be used to send the portal username and password.
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* Indicates required question
Type of Request
*
Choose
New user
Forgot password
Consumer Name
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Last 4 of consumer's social security number
*
Your answer
Email
*
This email will be used to communicate login information to the Patient Portal
Your answer
Phone number (area code included)
*
This phone number will be used to communicate if the email above is not available
Your answer
If you are a guardian requesting access, complete the information below:
Guardian's name
Medical Records will verify guardian information in the consumer chart prior to authorizing access. If further questions are required, you will be contacted at the information provided within the form.
Your answer
Guardian's relationship to consumer
Your answer
Additional questions
If you have any additional questions, you can contact our Medical Records department at (432) 264-4250 or
medicalrecords@wtcmhmr.org
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