Patient Portal - Patient Access Request

If you are a parent/legal guardian, please return to the previous screen and select "New Account: I'm a parent/legal guardian for a patient 0-15 years". This form is for patients only.

Patients 12 years or older may request to sign up for a Health Hub account. Please complete all steps below:

Step 1 | Patient Details:

Health Service:

Please select the primary Health Service you attend. This information will be used to send your request to the correct location for processing.

First name:

Last name:

Date of Birth:

Your UR number (if known):

Street address:

Suburb/Town:

State:

Post Code:

Phone:

Email:

Step 2 | Identity Verification:

To keep our patient's medical records protected and secure, a copy of your photo identification (which displays your full name and date of birth) is required to verify your identity. Proof of identification must be provided by email by choosing the relevant Health Service link below. The photo ID will be used solely to verify identity and will not be permanently stored.

The Royal Melbourne Hospital

The Royal Women's Hospital

Peter MacCallum Cancer Centre

Were you able to successfully send proof of identification as described above?

Yes

ID Reference number:

Please supply the reference number found on your ID - e.g. Driver's licence, passport, proof of age card etc.

Important: Your account access request will not be reviewed or approved until a valid form of photo identification has been recieved (e.g. driver's licence, passport, proof of age card).

Step 3 | Please read and sign this form:

You must read, understand, and agree to the Terms and Conditions of Use posted on the Health Hub website before an account can be provided. Once you have read this document and agree to the terms, please sign the form below:

Click the statement to the right to sign this form electronically - it will turn blue when clicked.

By signing this form electronically, I certify that I am the patient identified above and all information I have provided is correct. I acknowledge that I have read, understood and agree to abide by the Health Hub Terms and Condtions of Use linked above.

Based on the information you provided, we will post, email or text you the details to sign up for Health Hub. Please allow seven business days for these requests to be processed. Should we have any questions regarding your submission, we will contact you via the telephone number or email you have submitted.

Patient Access request

Step 1 | Patient Details:

Step 2 | Identity Verification:

Step 3 | Please read and sign this form: