MyChart - Sign Up

We need some information from you in order to grant you a MyChart account.

Individual MyChart account holders must be at least 13 years old and have a medical record on file with Saint Francis Health System. If you are 13-17 years old you must use your own personal email address. Parent and legal guardian email addresses will not be accepted.

First, we need to collect some information about the patient.

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Now, we need to collect some information about you. After you submit the request, we will set up your appointment.

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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

Gender

Female Male Unknown

Last four digits of SSN

Email address

Verify email address

Home phone

Mobile phone

Work phone

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Name

Address

Other Information