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Patient Information

We need some information from you in order to create a MyChart account. Complete the form below and follow the instructions to create your account. If an existing MyChart account is found, you will be directed to reset your password or request your username. MyChart accounts are granted to patients who are 15 years of age and older. It could take up to a week for processing and verification. Once approved, you will receive an email or a letter with your activation code and instructions on how to activate your MyChart account. If you have any questions, please contact your clinic.

Minor Accounts

Parents or guardians can access their minor’s account by logging into their own MyChart account. Have an existing MyChart account and need access to a minor’s account? Click here to access our proxy forms then complete the form and bring it to your next visit. Don’t have a MyChart account? Complete the form below to create an account of your own.

Minor Accounts

First, we need to collect some information about the patient. If you have any questions, please call or email us.

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Now, we need to collect some information about you. After you submit the request, we will set up your appointment. If you have any questions, please call or email us.

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Name

First name

Middle name

Last name

Address

Other Information

Date of birth (MM/DD/YYYY)

Legal sex

FemaleMaleUnknown

Last four digits of SSN

Email address

Verify email address

Home phone

Mobile phone

Thank you - your request has been sent to the clinic. You will receive an activation code in your mail or email within a week.

If you have any questions or if you do not receive your activation code, call customer service.

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We were unable to verify your information, so your request has been sent to the clinic. You will receive an activation code by mail or email within a week.

If you have any questions or if you do not receive your activation code, call customer service at (855) 435-1426.

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We are experiencing technical difficulties at this time. Please try again later or contact our customer service line for assistance.

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We were unable to verify your identity using the information provided. Please call or email us for assistance.

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We are experiencing technical difficulties at this time. Please contact our customer service line for assistance.

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There is an existing account for this person.

From the login page, click "Forgot username?" or "Forgot password?" to access this account.

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There is an existing account for this person.

Please contact us directly to restore access to your account.

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Ask the patient to resend the invitation.

We are experiencing technical difficulties at this time. Please try again or contact our customer service line for assistance.

Unable to complete MyChart signup. Please contact customer service at (855) 435-1426 for help activating your account.

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In order to grant you a MyChart account, we will verify your identity using questions from a third-party verification system. Once verified, you will be able to create your MyChart account. If you have any questions, please contact your clinic.

We are checking with a third-party system to verify your identity. This may take several seconds.

Unable to Verify Your Identity

We are unable to verify your identity using the information provided. Please call or email MyChart Patient Support for assistance.

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Unable to Verify Your Identity

We are experiencing some technical difficulties while communicating with the third-party verification system. Please contact our customer service line for assistance.

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These questions are generated by a third-party system to verify your identity.

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