Patients Know Best Registration Request Form

Patients Know Best Registration Request Form

Complete this form to register for your PKB online health record from Dartford & Gravesham NHS Trust

First name Required

Middle names

Surname Required

Telephone number (you will receive a call from our Health Records team on this number in the next few days to verify your identity) Required

Date of birth Required

NHS number (if known)

Address Required

Town/City

Postcode Required

E-mail address Required

Confirm e-mail address Required

Request submitted by

(Staff only) Staff name

(Staff only) Department

(Staff only) Have you explained to the patient they should expect a telephone call to verify their identity? Required

Why do we need this information?

We need your personal details in order to set up your online account. Everything you’ve provided should already be on our patient records system. If any of the information here doesn’t match with what we have in our records, we’ll check with you before setting up your online health record. The information you’ve entered in this form is used and stored in line with the Trust’s Information Governance and Data Protection policies.

What happens next?

Before we can give you access to your online health record through Patients Know Best, we need to verify your identity. You should expect a telephone call from our Health Records team to go through this process. Once we’ve verified your identity, we’ll set up your PKB record, and you will receive a link via email to set up your password.

I agree to the privacy policy.

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