Name: | DOB: | MRN: | PCP:

Sign up for MyChart

Welcome to MyChart

What is MyChart?

MyChart offers patients access to their personalized medical and health insurance information over a secure Internet connection.

Who can enroll?

Who can enroll?

  • Patient 13 years of age or older
  • Parent/Guardian of a child of CT Children's
  • Internet access

How do I register?

1. First, please read the MyChart Terms and Conditions statement

Click here for Terms and Conditions - English

Click here for Terms and Conditions - Spanish

2. Then print out one of the applicable documents and fill out the following information confirming that you have read, understood, and agreed to the items detailed in the Terms and Conditions.

Click here to get Patient Sign up Form - English

Click here to get Patient Sign up Form - Spanish

Click here to get the Parent/Guardian or Patient over 18 Sign up Form - English

Click here to get the Parent/Guardian or Patient over 18 Sign up Form - Spanish

Send this form to us at:

CT Children's Medical Center
Attn: HIM/MyChart
10 Columbus Blvd 4th Floor
Hartford, CT 06106

What happens next?

Once we receive your signed consent form, we will send access instructions and a personalized secure activation code to your email address you have provided.

How can I contact your organization?

Please feel free to contact us if you would like the consent form mailed to your home address or if you have any questions about this program.

Thank you for your interest!