MyChart - Signup

Welcome! Aspirus is pleased to offer this online request service for your MyAspirus account. Your account will be your access to your personal and secure electronic medical record. Please fill out all fields, as they are required to verify your identity. If we are unable to directly match you at this time we will send your activation code US mail.

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.

Indicates a required field

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

Social Security number

NNN-NN-NNNN

Gender Male Female

Home phone

NNN-NNN-NNNN

Mobile phone

NNN-NNN-NNNN

Email address

Verify email address

Finally, as a spam prevention measure, complete the CAPTCHA below.

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Request an Activation Code

Request Submitted

Request Submitted

Request Submitted

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