Waiver to Enroll in MyChart

Please correct the errors described below.

Add new row

Parent/Guardian Accessing MyChart: (for patients under 13)

By typing your name below, you are signing this application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this application.

**Please note that although we understand that some of these features would be beneficial, we are not able to modify them **

MyChart Features

  • Access to letters, health forms, lab results and growth charts
  • Request a refill of medication
  • Pay bills online
  • Review visit summaries
  • View upcoming appointments
  • Send NON URGENT messages to our front desk and triage nurses
  • View tip and informational sheets
  • Update your medical demographics. Make changes to your address, insurance and contact information
  • Update family medical history, current health issues, allergies and medications

Your information will be encrypted.