Clinical Viewer Access Request Form

Health Information Exchange User Request Form
To have access to the comprehensive health information available in CyncHealth, health systems or individual health providers will need to have a signed participation agreement. 

If you need assistance with who your facilities Designated User(s) or Designated Authorizer is please select to send the information and it will be sent to you.
If you need assistance with who your facilities Designated User(s) or Designated Authorizer is please select to send the information and it will be sent to you.

Instruction: This form is to be completed by the organization’s appointed Designated Authorizer on file with CyncHealth only and a confirmation email will be sent to the Designated Authorizer.
Instruction: This form is to be completed by the organization’s appointed Designated Authorizer on file with CyncHealth only and a confirmation email will be sent to the Designated Authorizer.

Other Fields

Your name
Verification Code