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PATIENT PORTAL CONSENT FORMFamily Practice Specialists of Richmond3742 Winterfield RoadMidlothian, VA 23113The patient portal is a secure web portal that allows you as a patient to access medical records including medications, lab results, and medical history via a secure, encrypted internet connection. It also allows you to request refills and send messages to staff members online. A link to our portal is available on our website.PLEASE KEEP IN MIND: IF YOU SIGN UP FOR THE PORTAL, A MORE RAPID FORM OF COMMUNCIATION, THIS WILL BE OUR PRIMARY METHOD OF CONTACTING YOU WITH YOUR LAB AND TEST RESULTS.However, we will call you on the phone if we need to reach you regarding abnormal results, or for appointment reminders, etc.If you are interested in participating in the Portal, please read the following policy carefully and sign at the bottom of the page:The patient portal requires you to check your email often. If you do not use email or only check it rarely, the portal is not for you.We are offering the patient portal as a convenience to you at no cost. We do not sell or give away any private information, including email addresses, without your written consent. We reserve the right to suspend or terminate the patient portal at any time and for any reason.Please note that the portal is not checked or updated on weekends.We do not refill controlled substances over the portal.If you find you are not receiving emails from us, please check your JUNK email folder before contacting us.By using this patient portal, you agree to protect your password from any unauthorized individuals. It is your responsibility to notify us should your password be stolen. You agree to not hold Family Practice Specialists of Richmond responsible for any network infractions beyond our control.Your signature below confirms that you have read and fully understand our policies for online communications and wish to participate in our patient portal.PLEASE PRINT CLEARLYNAME __________________________________________________________________________________EMAIL ADDRESS________________________________________________________________________SIGNATURE__________________________________________________________DATE_____________ ................
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