Enroll Patients
Unlock Support and Resources
To complete enrollment, your patients will need to provide program consent and authorization to share health information.
Enrollment form
To initiate enrollment, fill out the form with your patient and submit it online, by fax or by email. Once the completed form is submitted, your patient's Case Manager will call you to confirm enrollment and discuss next steps based on the services requested.
Enrollment form
Download nowEnrollment form instructions
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Additional ways to obtain patient consent
Patients must provide their consent and HIPPA authorization to access YourBlueprint services and support.* You can have your patient sign the consent in office through DocuSign using the Online consent form option. If your patient cannot provide consent in office, patients can access this option through the YourBlueprint website, or you may download the consent form and send it to your patient.
*Patient consent form must be completed and signed by the patient
