Patient Portal Invitation | Peachtree Park Pediatrics

Patient Portal Adult (18+) Invitation Request

IMPORTANT: THIS FORM IS FOR PATIENTS 18 YEARS AND OLDER AND IS TO BE COMPLETED BY THE PATIENT

If you are the parent of a patient under the age of 18, please click here to request an invitation for access to your child’s health record.
The patient portal is for established patients only. New/prospective patients should call our office to schedule an appointment prior to requesting a portal invitation.

Please fill out the form below to receive an invite to join our patient portal.

Name*
First Last
Date of Birth*
Email*
Optional
- I would like to give access to my online medical records via Follow My Health to the following parent/guardian:
Name*
First Last
Relationship to Patient(s)*
Email*
Patient Signature (full name)*
Today's Date*
**You will receive an email within a few days from noreply@followmyhealth.com that will
include an invitation link, and instructions to help walk you through the registration process.

** The security code will be your year of birth (XXXX).

**Follow My Health is compliant under all HIPAA regulations.