Request for Access Through NMC-Portsmouth Firewall

This form represents a formal request to allow outside network traffic access to resources within the Naval Medical Center-Portsmouth architecture. The network and security personnel will evaluate the information for potential security risks and will forward request to the approving authority. Please restrict requests to mission critical needs only so as to maintain the secure posture that is being implemented.

Your Name: Phone:
          Email:

Information about the NMED Device or Resource

Site Name:
Site Admin:
Site Admin Phone:

Internal Resource Name / Description:
Internal Resource IP Address:
Port(s) requiring access:
Resource Administrator:
Resource Administrator Phone:
Justification of Mission Critical Requirement:

Information about the outside traffic requiring access

Source IP Address:
Source Description:

Information about the POC permitted to make requests for a site. If you do not have a site security ID this information is required. The Site admin should be a government or military employee. The backup POC's may be anyone assigned by the Site Admin. These contacts will be used to validate the authenticity of a request and provide feedback and status info on requests.

Site Name:
Site Admin:
Site Admin Phone:
Site Admin Email:

Site Backup POC:
Site Backup Phone:
Site Backup Email:

Site Backup POC:
Site Backup Phone:
Site Backup Email:

We realize the time sensitive nature of all requests and will promptly evaluate requests as they are submitted. Please allow time for them to be considered.

After completion – please click on the Submit Request button below.

Please direct all questions or inquiries to:
NMCP Command Information Assurance Manager (IAM)
(757) 953-9364