Register by Mail

Please fill out the form below. All fields are required to verify your identity with Atrium Health Wake Forest Baptist.
This form may only be used to request an account for you. To protect our patients' privacy, you need authorization to access a family member's or other individual's health record. Parents, guardians, spouses, adult children or partners who need access to another account may request Proxy Access. Please read Proxy Access Instructions.
*Indicates a required field