PatientPortal Practice Deactivation Form

To deactivate your PRACTICE from PatientPortal, please complete the following PatientPortal Deactivation Form.

IMPORTANT: If you wish to deactivate an INDIVIDUAL PROVIDER, you will need to fill out our SureScripts Deactivation form here –

Fields marked with an asterisk (*) are required.

Check the types of e-mail notifications you want sent to this address: