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MyCarePortal Enrollment Webform

MyCarePortal Patient Enrollment Form 

MyCarePortal is a secure, online patient portal that allows you to view portions of your health record from the following partner organizations:  

SWO Map

  • Alexandra Hospital Ingersoll ⚕
  • Four Counties Health Services
  • Listowel Wingham Hospitals Alliance
  • London Health Sciences Centre
  • South Huron Hospital Association
  • St. Joseph's Health Care London
  • St. Thomas Elgin General Hospital
  • Strathroy Middlesex General Hospital
  • Tillsonburg District Memorial Hospital ⚕

  • Woodstock Hospital

    ⚕ These partner organizations have recently merged as Rural Roads Health Services

To enroll in MyCarePortal: 

You must be 16 years of age or older and have a unique personal email address (i.e. not shared with anyone else, not a work or school email account).  The email address you provide will be used to receive information about your MyCarePortal account.

MyCarePortal access will not affect your legal right to access your health record by other means.  To request an electronic/paper copy of your health record, contact the Health Information Management (Health Records) department at the facility where you received care.
 

Instructions to enroll in MyCarePortal: 

  • Carefully complete all fields that apply to you and double check the form before submitting your answers.
  • Submit the required supporting documentation in order for the MyCarePortal enrollment team to verify your identity and connect you with your Personal Health Record.

Section A - Patient Information 

Enter the name as it appears on your government-issued identification. 
Fields marked with an * need to be filled out.

For security reasons the more information you are able to provide will be used to verify your identity and ensure you are connected to the records that belong to you.  This verification is required prior to your invitation to MyCarePortal.
Example: For June 10, 1981, enter: 19810610

10. Challenge Question 

Please select one of the following challenge questions listed below and provide the answer.  Remember or record this answer in a safe place.  This will be required to claim your MyCarePortal invitation.

Example: For June, 1981, enter 061981
Please do not use special characters (like @, #, $, %, etc.) when entering your Challenge Answer. Special characters may cause errors or problems with your submission.

Section B - Uploading Photos of Required Identification

In order to verify your identity, you must upload two (2) photos

  1. A photo/scan of the front of one acceptable government-issued identification

  2. A photo of you holding acceptable government-issued photo identification next to your face

The following are the acceptable types of government-issued identification for MyCarePortal enrollment. Your government-issued identification must be valid at the time of your enrollment request. Expired documentation will not be accepted. 

Acceptable Identifying Documents for users over 16 years

  • Ontario Health Card (Preferred)
  • Government-Issued Passport
  • Driver’s License issued by a Canadian Province or Territory (including graduated Driver’s License)
  • Secure Certificate of Indian Status (SCIS)
  • Permanent Resident Card (PR Card)
  • Ontario/Provincial Photo Card
Description of Image
This is an example of a Photo of one holding their ID

Please Note: Enrollment will not proceed without photos of the required identification.

Section C - MyCarePortal Information

  • If your chart does not have an email address linked, we will add your personal email to your patient chart.  The email you provide will receive an email invitation to activate your account in the MyCarePortal. See https://www.MyCarePortal.ca/FAQ or https://www.MyCarePortal.ca/Security for more information about how we may contact you via email.
  • MyCarePortal is a secure, online patient portal that allows you to view portions of your confidential medical information from the partner organizations.
  • It is your responsibility to create a strong password that is unique and different from other passwords you might use.
  • You must not share your MyCarePortal login and password. You will change your password if you believe it may have been compromised in any way.
  • You are responsible for the security of your information and protection from online threats.  Ensure thoughtfulness when accessing the MyCarePortal application (i.e., when using a public computer or borrowed device where security of the computer system is not known; signing out of the MyCarePortal account when finished).
  • MyCarePortal contains an access log that is viewable by you.  This log will keep track of what is viewed or downloaded by you.
  • The partner organizations have the right to unenroll users from MyCarePortal as stated in the MyCarePortal Terms of Use Agreement.
  • The partner organizations may contact the user electronically (i.e. email) with information about MyCarePortal or to request feedback related to the User’s experience.  
  • You are responsible for ensuring the accuracy of the information provided for enrollment. 
  • When claiming the MyCarePortal invitation you will be required to agree to the Terms of Use and the Privacy Policy.
  • You understand that participation in MyCarePortal is completely voluntary.

By clicking "I Agree" below, I acknowledge that I have read and understand this MyCarePortal Patient Enrollment Form.

I Agree

Participating Hospitals

Listowel
Huron Health
Woodstock Hospital
MHA
St. Joseph's Health Care London
Rural Roads Health Services
St Thomas Elgin General Hospital
London Health Sciences Centre & Children's Hospital