MyChart - Sign Up

Must be 18 or older to use this service.

If you are a minor age 12-17, you can email [email protected] for an electronic activation form, or request MyChart access at your next doctor's appointment. You can also visit our FAQ page for a printable form.

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.

Indicates a required field

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.

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.

Must be 18 or older to use this service.

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.

Indicates a required field

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

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

Terms & Conditions:

Affirmation:
I hereby affirm that I am the person/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 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 know in writing at any time. This change will become effective no later than the next business day after the date that Essentia Health receives my request and will not apply to information that has already been released before this effective date.
Essentia Health 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 am currently an Essentia Health patient and 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 Essentia Health MyChart Terms and Conditions. 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

Affirmation
I hereby affirm that I am the person/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

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 know in writing at any time. This change will become effective no later than the next business day after the date that Essentia Health receives my request and will not apply to information that has already been released before this effective date.
Essentia Health 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 am currently an Essentia Health patient and 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 Essentia Health MyChart Terms and Conditions. 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.

Sign Up

Name

Address

Other Information

Sign Up

Patient Information

Name

Address

Other Information

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