Welcome to the eHealth Technologies�Patient Authorization Portal

Please select the appropriate form, or if you do not know which form to fill out
please contact customer service at 877-344-8999 (Option 1)

English Language Release Form

Spanish Language Release Form

 

Request Password Reset

What is Your Login?

Please fill out this form to begin your password reset request. In the next steps we will verify your identity using information currently saved in your profile, including your Secret Question and Answer, alternate email address, and SMS text messaging address. If your identity cannot be reliably verified or there is insufficient information in your profile, you will have to contact your account administrator directly for assistance.

Please type the text seen in the image, below, into the "Security Code" box.

The security code is the text that you see in the image, above. Use of this code helps us prevent abuse of this form by automated programs.