Capital Health Hospital Patient Portal Request Form

  Please complete the below form to request access to the Capital Health Hospital Patient Portal. Once you complete the form,
  you will receive an e-mail notification with your user name and password to be able to log into the portal.

  Please remember that this portal is not for urgent medical needs.
  If you are experiencing a medical emergency, please call 911 or go to the nearest emergency room immediately.

  Who Is Eligible?

  If you were admitted to one of our hospitals or visited one of our emergency departments on or after July 15, 2015, our portal offers secure access to summary records from your visit.
  Outpatient Lab results and diagnostic studies after July 2016 are now available on the portal.

  Our portals are available to patients 18 years of age or older. Parents or guardians of patients under the age of 18 who wish to have access to their child’s medical records are asked to call
  our Health Information Management Department at 609.303.4085 (Hopewell) or 609.394.6007 (Regional Medical Center). You can also contact us by visiting our Contact Us form and
  clicking on "Medical Records" in the subject field.

  If you are a patient at one of our doctors’ offices, please click here to visit your portal and sign in.


  Already have an Account?

  Click Here to visit the log-in page and sign in. If you are trying to get your password for the doctors’ office portal, please contact your doctor’s office.

*First Name:
*Last Name:
*Date of Birth (MM/DD/YYYY):
*Social Security Number (last 4 digits only):
*Email Address:
Address Line 1:
Address Line 2:
*Zip/Postal Code:
*Primary Phone Number
(i.e. 2155551234, no dashes):

Your activation code will be sent to you after the request is validated. If there are any questions regarding your submission, you will be contacted via the phone number submitted.