Sign Up

There were some errors found in the form. Fix these errors and submit again.

Patient Information

We need some information from you in order to grant you a MyChart account. Once submitted, it could take up to a week for processing and verification. Once approved, you will receive an email or a letter with your activation invitation and instructions on how to activate your MyChart account. If you have any questions, please contact your clinic.

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 805-324-9439.

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 805-324-9439.

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 805-324-9439.

Indicates a required field.

Error: We are experiencing technical difficulties at this time. Please try again.

Name

First name

Middle name

Last name

Address

Other Information

Date of birth

Email address

Verify email address

Legal sex

FemaleMaleUnknownChoose not to discloseIntersex

Home phone

Mobile phone

Last four digits of SSN

Thank you - your request has been sent to the clinic. You will receive an activation code in your mail or email within a week.

If you have any questions or if you do not receive your activation code, call customer service.

Back to Login Page

We were unable to verify your information, so your request has been sent to the clinic. You will receive an activation code by mail or email within a week.

If you have any questions or if you do not receive your activation code, call customer service at 805-324-9439.

Back to Login Page

We are experiencing technical difficulties at this time. Please try again later or contact our customer service line for assistance.

Back to Login Page

We were unable to verify your identity using the information provided. Please contact customer service at 805-324-9439 for assistance.

Back to Login Page

We are experiencing technical difficulties at this time. Please contact our customer service line for assistance.

Back to Login Page

There is an existing account for this person.

From the login page, click "Forgot username?" or "Forgot password?" to access this account.

Back to Login Page

There is an existing account for this person.

Please contact us directly to restore access to your account.

Back to Login Page

Ask the patient to resend the invitation.

We are experiencing technical difficulties at this time. Please try again or contact our customer service line for assistance.

Unable to complete MyChart signup. Please contact customer service at 805-324-9439 for help activating your account.

Back to Login Page

You may be redirected after a few seconds.