Portal Request for Trevor Griffen, MD

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Portal Request for Trevor Griffen, MD

Please fill out this form to request a new portal account for my practice using Sessions Health. The portal can be used for both medical communication and to request medical or billing records if you are a current or former patient.

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Email *

Your email

Name (of patient): *

Your answer

Date of Birth (of patient): *

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Your name (if other than patient):

Your answer

Your relationship to the patient (if other than patient):

Your answer

Reason for portal request:

Existing Patient - Need Portal

Former Patient - Medical/Billing Records Request

Other:

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A copy of your responses will be emailed to the address you provided.

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