Required Portal Forms

Required Portal Forms

To gain access to the patient portal, you may need to complete a required form below, depending on your situation. To access the required portal forms, click on the required form below. For questions, about which forms you need to fill out, please check out our Frequently Asked Questions, or give us a call at 512-324-0180.

Forms can be turned in at the time of registration to the hospital. If you are already registered to the hospital and only need to request access to the portal, you may turn these forms in to the Health Information Management Department. For more information, please visit Medical Records.

Patient Portal Minor Form
To sign up for access to your minor child’s portal, please complete this Minor Child Proxy Form. Completing this form will establish a Patient Portal record for you and your child. You will need to submit a government issued ID for verification when completing this form.

  • Patients 0-12 years old with parent/guardian requesting access 
  • Form signed and scanned 
  • Government issued ID required for verification purposes 

Patient Portal Request Form (Adult)
To sign up for access to your patient portal, please complete this form. You will need to submit a government issued ID for verification when completing.

  • Patients 18 years or older 
  • Access to their own portal 
  • Form signed or verbal consent documented; scan form 
  • Government issued ID required for verification purposes 

Proxy Forms

Patient Portal Minor and Proxy Form
To sign up for access to your minor child’s portal, please complete this Minor Child Proxy Form. Completing this form will establish a Patient Portal record for you and your child. You will need to submit a government issued ID for verification when completing this form.

  • Patients 13-17 years old with patient’s parent/guardian requesting access 
  • Signed by patient and proxy and scanned 
  • Government issued ID required for verification purposes

Patient Portal Proxy Form (Adult)
To sign up for access to a patient’s portal that is not your own, please complete this Proxy Form. Completing this form will establish a Patient Portal record for you and the listed patient. You will need to submit a government issued ID for verification when completing this form.

  • Patients 18 years or older, giving access to parent/guardian 
  • Signed by patient and proxy and scanned 
  • Government issued ID required for verification purposes 
  • Use Form D to revoke access