MyChart - Sign Up

We need some information to grant you a MyChart account. After you submit this request, it may take up to a week for processing and verification. When you're 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 us at 419-294-4991 ext. 1974.

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 419-294-4991 ext. 1974.

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 419-294-4991 ext. 1974.

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 419-294-4991 ext. 1974.

First, we need to collect some information about the patient. If you have any questions, please contact us at 419-294-4991 ext. 1974.

Indicates a required field

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 419-294-4991 ext. 1974.

Indicates a required field

First name

Middle name

Last name

Date of birth

Legal sex

Female Male Unknown Patient Refused Other Nonbinary X

Home phone

Work phone

Email address

Verify email address

Mobile phone

Medical record number

Social Security number

Sign Up

Name

Address

Other Information

Sign Up

Patient Information

Name

Address

Other Information