If not previously enrolled or if you're having issues with self-enrollment, please use this form to request enrollment.
This form is only to be used when requesting access to your own health records. A parental proxy access request form must be completed in person first to gain access to a minor's health records.
Once you have been manually enrolled by our staff, you will receive an email from mybchportal@bchsi.org. Please check your inbox for this email. It will contain instructions for completing your enrollment.
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