How to participate in Wellport at no charge
Simply read print and sign the consent form. Bring it to your participating doctor’s office or health care facility listed here.
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- Print out the consent form and complete it with careful attention to making sure your email address is legible.
- Either mail or fax it along with a copy of a government issued identification AND a copy of your insurance card.
- MAIL: Wellport, 255 Low Street, Newburyport, MA 01950
- FAX: (978) 462-4596
- We will make your Clinical Health Summary available to authorized clinicians.
- We will email you instructions and a registration code for your Personal Health Summary.
Parents of children under twelve years of age
Simply read and print out the consent form and bring it to your child's participating doctor’s office or health care facility listed here.
Minor children between 12 and 17 and their parents
- Read Letter to Parents.
- Print out the Consent Form both child and parent sign it and bring it to any listed health care facility attended by the minor child.
Important: Do not mail or fax forms for those under 18 years of age.