My Child Registration Request

To register an account for our My Child Patient Portal, please complete the required information below. An email account is required to register. Neither Pediatrics East nor Children's Hospital of Alabama will share or distribute your email address.

By submitting this form, you are authorizing Pediatrics East to activate your child's patient portal account which is managed by eClinicalWorks (Pediatrics East's electronic health record system software company). All of your information is secure and is in compliance with the Health Insurance Portability and Accountability Act (HIPAA). Due to privacy concerns, all of the information must match the information on file. If any information has changed or is incorrect, you will be required to call our office to activate your child's account.

If you have more than one child that is cared for by Pediatrics East, you must submit a separate registration for each child.

Please allow 3 business days for your account to be activated. You will receive an email with a username and temporary password once your account has been activated. If you do not receive an email within 3 business days, please contact our office to be activated as the information on file may not be correct.

* Indicates required information
Child's Name *  
Date of Birth *  
Parent/Guardian Name *  
Email *  
Primary Telephone Number *  
Primary Office Location *  


Before clicking the submit button, please review your information. You will not have the opportunity to edit it.