All fields are required.
You will need your own activation code to sign up.
Request an activation code
If you are a proxy or you want an activation sent to you, please complete and return one of these forms:
Enter your activation code as it appears on your enrolment letter. Your code is not case sensitive.
Enter your date of birth in the format shown, using 4 digits for the year. If you are a proxy signing up to access another patients' record this is your date of birth.