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TeleNP Health

Patient
Registration

PATIENT ID VERIFICATION

To ensure we can provide certain online services:

  • you are required to confirm your registration and provide proof of your address and identity

  • One form of identity must contain a photo of yourself and the other must provide evidence of your current address.

  • You can upload copies of your identification materials with the form below:

Identification Upload

Do you have a state issued Identification Card?
Yes
No
Does your identification match the state of residence/ patient registration information.
Yes
No

This form collects your name, other personal information, and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice. Please read our Privacy Policy to discover how we protect and manage your submitted data.


The internet is not a secure place, however, we have gone to great steps in making sure the information you submit to us is as secure as possible. We use SSL (Secure Socket Layer) certificates to encrypt the communication between your computer and our web server. If you are not completely happy to provide information via the internet please contact the practice at contactus@telenphealth.com and we will walk you through submitting the required materials through our patient portal.

Please note, you must submit these items before your scheduled appointment.


Thank you for your cooperation!

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