Home / Patient Portal Registration Patient Portal Registration Please complete the form below to register for the Coastal Horizons Patient Portal. Please enable JavaScript in your browser to complete this form.Name *FirstLastDate of Birth * Birth of Security Last 4 Digits of Social Security Number *Email *Terms of Registration *By entering my personal information into the form above and selecting SUBMIT, I consent to receive communications from Coastal Horizons Center Inc. and its electronic health record vendor, Welligent, by email. Although this website is protected by SSL encryption, please note that Coastal Horizons Center Inc./Welligent cannot guarantee the security of an email transmission. I acknowledge and agree that email is not a secure form of communication and that there is a risk an unauthorized party may intercept your communication.SUBMIT
