MyChart - Sign Up

Must be 18 or older to use this service.

If you are a minor age 12-17, you can request MyChart access at your next doctor's appointment.

Complete the form below. This information must match your medical record.

Once you have filled out the form below, you will be routed to a verification service called Experian where you will answer 4-5 questions to verify your identity. We do not have access to the information you share with Experian.

Once your identity has been verified, you will be able to proceed with creating a MyChart account.

If you are unable to create an account, our MyChart Sign Up team will review your request and respond by email within two business days.

If you need to access another patient’s MyChart account, please do not use this form.
Click here for more details on how to request proxy access.

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Follow these steps to sign up for a MyChart account.

Enter your personal information.

Verify your contact information.

Choose a username and password.

If you have any questions, please contact us at 1-888-868-9292.

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Follow these steps to sign up for a MyChart account.

Enter your personal information.

Verify your identity.

Choose a username and password.

If you have any questions, please contact us at 1-888-868-9292.

Indicates a required field

Must be 18 or older to use this service.

If you are a minor age 12-17, you can request MyChart access at your next doctor's appointment.

Complete the form below. This information must match your medical record.

Once you have filled out the form below, you will be routed to a verification service called Experian where you will answer 4-5 questions to verify your identity. We do not have access to the information you share with Experian.

Once your identity has been verified, you will be able to proceed with creating a MyChart account.

If you are unable to create an account, our MyChart Sign Up team will review your request and respond by email within two business days.

If you need to access another patient’s MyChart account, please do not use this form.
Click here for more details on how to request proxy access.

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First, we need to collect some information about the patient. If you have any questions, please contact us at 1-888-868-9292.

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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 contact us at 1-888-868-9292.

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We need to collect some information about the patient in order to schedule this appointment. If you have any questions, please contact your clinic.

First name

Middle name

Last name

Date of birth

Legal Sex

Female Male Unknown X

Social Security number

Home phone

Mobile phone

Email address

Verify email address

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Terms & Conditions

Affirmation
I hereby affirm that I am the patient identified above. I understand that I may be subject to penalties under law for submitting false or misleading information in connection with this request to access MyChart.

Authorization

By submitting this form I agree to allow Essentia Health and its independent Community Connect customers to release my personal health information to me via an online MyChart account. I will be able to access information maintained in MyChart for my personal use.

I understand that:

This authorization will be valid for as long as I maintain an active MyChart account.
If I change my mind and no longer want MyChart access, I may let Essentia Health or its independent Community Connect customers know in writing at any time. This change will become effective no later than the next business day after the date that the request is received and will not apply to information that has already been released before this effective date.
Essentia Health and its independent Community Connect customers cannot be responsible for the confidentiality of information released to me, and cannot prevent me from releasing the information to another person. At that time, the information is no longer protected by federal and state privacy regulations.
If I do not create a MyChart account, I will still be treated and payment, enrollment and eligibility for benefits will not be impacted.
I designate my MyChart account as my preferred method of communication to receive reminders about preventive and follow-up care (excludes scheduled appointment reminders).
As part of this on-line account creation process I will be asked to confirm that I have read and agree to the MyChart Terms and Conditions for Essentia Health and its independent Community Connect customers. I understand that every time I use MyChart I agree to these Terms and Conditions.

By clicking "AGREE & SUBMIT" I confirm that I have read and agree to the terms of this authorization. I acknowledge that I am electronically submitting this authorization on my own behalf. I understand that I may be subject to penalties under law for submitting false or misleading information in connection with this authorization.

If the reCAPTCHA security feature does not appear, try using a different web browser. (e.g. Chrome, Edge or Safari)

Terms & Conditions

Authorization

I understand that:

This authorization will be valid for as long as I maintain an active MyChart account.
If I change my mind and no longer want MyChart access, I may let Essentia Health or its independent Community Connect customers know in writing at any time. This change will become effective no later than the next business day after the date that the request is received and will not apply to information that has already been released before this effective date.
Essentia Health and its independent Community Connect customers cannot be responsible for the confidentiality of information released to me, and cannot prevent me from releasing the information to another person. At that time, the information is no longer protected by federal and state privacy regulations.
If I do not create a MyChart account, I will still be treated and payment, enrollment and eligibility for benefits will not be impacted.
I designate my MyChart account as my preferred method of communication to receive reminders about preventive and follow-up care (excludes scheduled appointment reminders).
As part of this on-line account creation process I will be asked to confirm that I have read and agree to the MyChart Terms and Conditions for Essentia Health and its independent Community Connect customers. I understand that every time I use MyChart I agree to these Terms and Conditions.

Sign Up

Name

Address

Other Information

Sign Up

Name

Address

Other Information

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