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Patient Access Form

Patient Access Form Compatibility

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Consent for Patient Portal Access at Northeastern Vermont Regional Hospital: Only select the fields that apply

Gender

PATIENT ACCESS

PROXY ACCESS

ACCESS TO MINORS MEDICAL INFORMATION

Relation to Patient (Required)

MINOR ACCESS TO MEDICAL INFORMATION

1 + 15 =

*** TIME SENSITIVE***

Once you receive the initial email from no_reply@nvrh.org,
you have 72 hours to log in and create your personal ID and Password ***
Be sure to check your junk mail.