Request for Portal Registration

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  • PLEASE UNDERSTAND THAT YOU ARE SUBMITTING THIS REQUEST OVER THE INTERNET. DO NOT INCLUDE ANY SENSITIVE MEDICAL INFORMATION IN YOUR APPOINTMENT REQUEST. 1960 Family Practice respects the confidentiality of your personal information and promises only to use it for internal purposes as it relates to this request. If you are uncertain about transmitting this information over the Internet, please do not submit your form. Please call our scheduling department directly and they will assist you with your appointment. 281-586-3888 option 1.