KAP Portal Consent Form

Please correct the errors described below.

Patient Portal and Use of Electronic Communications

To better serve our patients, our office has established a Patient Portal, for some forms of communication. The Patient Portal is a simple way to access your child’s health information online. In addition, the Patient Portal allows you to:

  • View and request appointments
  • View and print immunization records for school and day care
  • Request prescription refills
  • Retrieve test/lab results
  • View billing statements and balance
  • Make secure credit card payments for balances
  • Communicate with our office by sending and receiving secure messages regarding lab results, medical questions, medication refill request, referral requests.

For routine matters that do not require immediate response, we ask that you contact our office through the Patient Portal . Please remember however, that this form of communication is not appropriate for use in an emergency. The turnaround time for routine patient communications is approximately one business day. Should you require urgent or immediate attention, please contact our office directly.

Communications relating to diagnosis and treatment will be filed in your medical record.

Patient Consent for Use of Electronic Communications

I understand that this office will not be responsible for information loss, delay or breaches in confidentiality that are due to technical factors beyond this office's control.

I understand and agree to the above electronic communications policy.

By signing below, you are agreeing that we may send medical related correspondence to you via email, and that we may respond to your emails to us via email.

By printing your name in the signature box, this is confirmation of e-signature.

Patient Portal Access should be available for:

Your message will be encrypted and can only be read by Kid Approved Pediatrics.