Welcome to MyChart - MyHealth

The Institute for Family Health is pleased to offer you MyChart - MyHealth, a secure Website on the Internet that you can use to review information about your health and communicate with your health center. You can use this service by logging into the MyChart - MyHealth web site with a special access code given to you by your health center. Once you have logged in, you can create your own user ID and password. MyChart - MyHealth is completely voluntary and is provided by the Institute for Family Health as a convenience to its patients.
PLEASE NOTE:  At this time, MyChart - MyHealth is only offered to patients 12 years or older.

Steps to Sign Up

  1. Print this page by clicking on the box above
  2. Fill in the information requested below
  3. Read the MyChart - MyHealth Terms and Conditions
  4. If you agree to the Terms and Conditions, check the “I agree to these terms & conditions” box.
  5. Sign the form and return it to your primary care doctor.  

Complete All Sections - Please Print Clearly

Last Name First Name Middle Initial
Date of Birth (MM/DD/YYYY)
Street Address
City State Zip
Email Address
Phone Number
Primary Health Center
 I agree to the MyChart - MyHealth Terms and Conditions (check box).
Signature of Patient/Authorized Person Relationship to Patient (if any) Date (MM/DD/YYYY)