*Required fields are marked with an asterisk.

 

 

HIMG Patient Portal Registration

 

 

(Click the blue link above then click "open" and "print")

 

This form requires a signature.

Please print, sign and return:

by mail:    HIMG                            by fax:    304-399-2114           by email:  patientportaladmins@uhswv.com

                     Attn:   Amanda Smith 

                     5170 U.S. Rt. 60 East

                      Huntington, WV 25702