Drs Robin Stephen, Ruth Barnett and Rebecca Pope



* Harbour Health Port Chalmers Limited

47 George Street

Port Chalmers

Dunedin 9023

Phone (03) 472 8026 Fax (03) 472 8027

Patient Portal Sign-up Form

ConnectMed offers a very flexible and convenient way for you to securely view your health information and advantage of online services 24/7 with an internet connection. This service is voluntary and you may opt in or out at any time. This service is only available to patients over the age of 16 years.

By signing up, you are able to:  Make appointments with your GP or nurse   Request repeat prescriptions          View your test results In the future other options may become available and you will be notified when they do.

How to sign up in the Patient Portal: You will receive a user name and password via the personal email account which you have nominated. Once you are logged into the portal you will have access to only your records.  You will also be asked to agree to the Terms and Conditions of using the portal, please read these carefully. You can review the Terms and Conditions as well as FAQ, the privacy policies and other general information at any time from the ConnectMed website.

To receive a username and password, please complete and return this form to a staff member in person at the health centre.     

Name: ___________________________________________________

Date of birth: ___________________

Personal email:  ____________________________________________________

I confirm that this email address is not used by anyone other than myself.

I confirm that I will maintain a confidential password at all times.

I understand that the patient portal is not to be used for urgent healthcare. I understand that access to ConnectMed is always at the discretion of the practice.

Signature:  ________________________________________  Date:  ____/____/____

For Office Use Only:    I have authenticated the identity of the person named on this form

Staff Signature:  _________________________  Date:  ____/______/______ 

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