Request to Access MyChart

Thank you for your interest in Driscoll Health System MyChart. This form is for a patient, age 13 or older, to request their own MyChart account. This easy-to-use tool can be accessed anywhere and gives you quick and secure access to your Medical record. To sign up for access to Driscoll Health System, please fill out and submit the form below for approval.

Once your request is approved, we will email or text you an activation code within two business days.  We will reach out to you if we have any questions about your information.

Patient Information:

Driscoll Health Plan Member:

If you are a Driscoll health plan member please enter your member ID below.

Additional infomation:

Please tell us how we can help you with this request.