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