MyChart - Signup

We need extra information to help us:
• Confirm your identity.
• Contact you by email, phone or mail.
As soon as we verify these details, we will email you an activation code. The email will explain how to finish the process of opening your MyCare account.
Any questions? Call (608) 775-0303 or (800) 362-9567, ext. 50303.

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We need some information in order to grant you a MyChart account. Enter your demographics here and in the next step we will verify your identity using questions from a third-party verification system. Once verified, 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 your clinic.

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Name

First name

Middle name

Last name

Address

Address information is required.

AddressCityStateZIPCountyCountry

Address	City	State	ZIP	County	Country
__Street__	__City__	__State.Title__	__Zip__	__County.Title__	__Country.Title__

Other Information

Date of birth

MM/DD/YYYY

Last four digits of SSN

NNNN

Email address

Verify email address

Home phone

NNN-NNN-NNNN

Work phone

NNN-NNN-NNNN

Request an Activation Code

Request Submitted

Request Submitted

Request Submitted

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