Health Jump
Have an account?
Login
Log In
Sign Up
×
Close
Forgot Password?
Remember me
Log in with Facebook
Log in with Google+
I accept Healthjump's
Terms of Service and Privacy Policy
.
Cancel
Add a doctor to your profile
×
Close
Please sign below to complete the request
I am authorizing Healthjump to send a fax to my doctor to request the information I have selected above, and I authorize Healthjump to follow up on this request if needed. I acknowledge that this request is valid for six months from this date, and that there may be a fee from my healthcare provider to complete this request.
×
Close
Please update profile to complete request
Hello, Please update the below listed details in your profile prior to requesting a document from your doctor.
×
Connect/Add Doctor
Would you like us to retrieve your health information from
Yes
No
Tell us which information to request?
Complete Medical History
Discharge Instruction
Visit Summary
Please sign below to complete the request
Reset
I am authorizing Healthjump to send a fax to my doctor to request the information I have selected above, and I authorize Healthjump to follow up on this request if needed. I acknowledge that this request is valid for six months from this date, and that there may be a fee from my healthcare provider to complete this request.
Please answer below questions:
What is your insurance ID?
When was your last visit to this office?
What are the last 4 digits of your SSN?
Don't want to answer these questions? Verify your email.
I have read, understood, and accept the above and the General Terms and Conditions as a condition precedent to acces to Patient Portal.
×
Close
Request Appointment
Date -
,
Time -
Visit Type:
Select Facility:
We will ask the practice to give you a call at:
Obtain Medical Record from
Would you like us to send your health summary to
?
Disclaimer :
This patient portal should not be used in the case of an emergency. Please call 911 or go to the nearest emergency room. You can expect a response to your message within two business days. Thank you.
No doctors found!
Please search for a doctor using the form above!
Home
About Us
Contact Us
Privacy Policy
© Copyright 2025 Healthjump V1.0