MLCHC Portal

New Portal Login Request

If you are an existing MLCHC patient and are age 18 or older, you may self-register for a portal account by entering the information requested below. We will verify your identity using the confidential and secure information in your patient medical record. If we are able to verify your information, you will receive an email within one business day from MLCHC with a temporary password to complete your registration.

* Required Fields

First Name *

Middle Name

Last Name *

Address *

City *

State *

Zip Code *

Phone 1 *

Ext

Type *

Email Address *

Confirm Email Address *

DOB *

Sex Assigned at Birth *

Please enter characters in the picture below

Anti-Spam Code *

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