Staff Portal

Add New Patient Record

Enter the patient's details. This creates both a clinical record and a user account for the patient portal.

Patient Identification

User Email (Optional)

Select an existing user or type a new email.

Full Name

Contact & Demographics

Phone Number (Optional)

Date of Birth (Optional)

Age (Optional)

Set Initial Password (Optional)

If set, patient can log in immediately. If not, they can set it via signup.

Medical Overview

General Medical Notes (Optional)

Specific Medical Conditions

Please check all that apply:

Diabetes

High Blood Pressure

History of Stroke/Heart Attack

Bleeding Disorders

Allergy

Asthma/Respiratory Issues

Supporting Documents

Upload X-ray Images or PDFs (Optional)

Drag & drop or click to select files.