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Adult consent for Your EPR online patient portal

Please complete this form if you wish to sign-up for our online patient portal.  Once your details are registered on the system you will receive an email to activate your account (the email should arrive within two working days so please be sure to check your junk and spam folders).  You will need to give us a memorable date so we can start the registration. We strongly advise you choose a date that is not your birthday. 

By signing up to the portal you are agreeing to the following: 

 

  • I understand the information provided in the information leaflet and the risks associated with online communication between the Trust and me, and consent to being enrolled.
  • Once registered, I agree to abide by the terms and conditions of using Your EPR.
  • I understand and agree with the information that I have provided and will advise the Trust if my email address changes.
  • I understand I need to keep my email address and password secure to prevent unauthorised access.
  • I agree with my email address being stored with my EPR record and used for the purpose of enrolment to Your EPR.

Consent for Your EPR

Consent for Your EPR
We would want two, any combination – So long as from different organisations – So could be bank statement from HSBC & Barclays
No photo ID
Must contain the name and address and be no more than six months old, unless it is an annual bill such as Council Tax

-Bank ,credit card or mortgage statement ok to blank out financial info
-Utility Bill -Elec – Water -Gas – TV (sky etc) phone, including mobile contract phone
-Council Tax bill
-Statement of entitlement to DWP benefits
-Letters from HMRC including National Insurance Number