Patient Portal Request

Request an Account

Use the form below to request a CHC Patient Portal account.
Patient Portal accounts are available for existing CHC patients who are 18 years of age or older.

In alignment with Washington State's minor consent laws ensuring access to confidential reproductive or mental health services, minors between 13-17 cannot have a Patient Portal account. Minor children age 12 and younger can have an account connected to their parent or guardian.
Patient Portal Account Request
Are you an existing CHC patient?*

Yes, I have been seen at a CHC clinic beforeNo, I am not an existing patient
As a new patient to CHC, we are unable to provide you with a Patient Portal account at this time. Please call 425-789-3789 to schedule an appointment.

You can request a Patient Portal account at your first appointment, or after you have been seen in the clinic.
In a few words, please give a short description of what you need help with on the Patient Portal:*
Is this portal account for a minor, between the ages of 13-17?*

YesNo
Please select the age that best describes the Portal account:
under the age of 9?

YesNo
In alignment with Washington State's minor consent laws ensuring access to confidential reproductive or mental health services, minors between 13-17 cannot have a Patient Portal account.
Parent or Guardian Name*

First NameLast Name
Date of Birth*

MonthDayYear
E-mail*
example@example.com
Patient Name*

First NameLast Name
Date of Birth*

MonthDayYear
Contact Number:*
E-mail*
example@example.com
I authorize a representative from CHC to contact me at the phone number listed above and set up a Patient Portal account to access my protected health information.*

I agree
Thank you for your request. Someone will reach out to you within the next 2-3 business days to help you with your Portal account.
For help, email our support team at PatientPortalSupport@chcsno.org
or call 425-789-3789.
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Request an Account

Patient Portal Account Request