Get the free Patient Portal User Agreement and Consent. Agreement and Consent Form
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Please DO NOT use Patient Portal to communicate with your Practice for urgent or emergency medical issues. If
you are experiencing an urgent medical need, please contact us by phone.
For emergencies
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How to fill out patient portal user agreement
How to fill out patient portal user agreement
01
To fill out the patient portal user agreement, follow these steps:
02
Access the patient portal website or application.
03
Click on the 'Sign Up' or 'Register' button to create a new account.
04
Provide your personal information, such as your full name, date of birth, and contact details.
05
Read the terms and conditions of the user agreement thoroughly.
06
Agree to the terms and conditions by selecting the 'I agree' or 'Accept' checkbox.
07
Review any additional privacy or security policies related to the patient portal.
08
Enter a username and password for your account.
09
Choose any security questions and provide their respective answers.
10
Confirm your registration by following the instructions provided.
11
Once the user agreement is filled out, you can log in to the patient portal using your credentials.
Who needs patient portal user agreement?
01
Patient portal user agreement is required for anyone who wishes to access and use a healthcare provider's online patient portal.
02
It is typically needed by patients who want to view their medical records, schedule appointments, communicate with their healthcare providers, request prescription refills, or access other online services provided by the healthcare organization.
03
By agreeing to the user agreement, patients agree to abide by the terms and conditions set forth by the healthcare provider and ensure the privacy and security of their personal health information.
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