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By using this form, you are requesting that Endwell Family Physicians email you the activation code so that you can access your patient portal.
This form is only for use where the portal being activated is for you, the patient. If you want another trusted person to have access to your portal as your representative, then please complete the Patient Portal Activation Code Request Form – Authorized Representative.
By signing this form, you indicate that you understand that email may not be secure. This means that there may be a risk to you that the information contained in the email could be intercepted and read by a third party. By signing this form, you indicate that you accept those risks and want EFP to email you your portal activation code. You understand that EFP will not use this consent to email any information other than your portal activation code.
To further protect the security of your account, EFP will use only the email address we have listed in your medical chart. You may supply an email address here, but if it does not match the email in your chart or we do not have an email address in your chart, we will be unable to send you the portal activation code by email.
To send you the portal activation code, EFP needs the following information:
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