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Patient Portal Access Form

Patient Portal Proxy Access Form

The completed forms and copies of the required ID can be brought to the Medical Records/Healthcare Management department at any DCH hospital, or sent via


U.S. Mail:
Release of Information
DCH Health System
809 University Blvd. E.
Tuscaloosa, AL  35401

Regional Medical Center: 205-759-7151
Northport Medical Center: 205-333-4724
Fayette Medical Center: 205-932-1259

For more information about MyDCH, click here.