North cypress medical center patient portal 2025

1. Click ‘Get Form’ to open the North Cypress Medical Center Authorization to Obtain Patient Portal Access Code in the editor.
2. Begin by filling out the Patient Information section. Enter your Middle Initial, First Name, Last Name, Date of Birth, Address, City, State, Telephone Number, and Zip Code accurately.
3. If you prefer to receive your access code by mail or fax, select one of the address options provided. Fill in the Recipient's Name, Address, State, City, and Zip Code accordingly.
4. Provide your Email Address for electronic communication regarding your request.
5. Review the authorization statement carefully. Once you understand and agree to it, sign and date the form. If applicable, print your name and indicate your authority if you are a representative.
6. Ensure that any necessary documentation of authority is included if you are acting on behalf of a patient.
7. Submit the completed form via mail or fax as instructed. Remember that a photo ID is required for in-person submissions and notarization is needed for mailed requests.

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