MyChart -

MyChart is a secure portal that connects patients and families with your provider via the MyChart App or the online portal. It offers useful information such as upcoming appointments, most lab and imaging test results, different types of visit summaries and much more!

Apply for access now by submitting this form.

Patient Information

Fields marked with an asterisk (*) are required.

First Name*

Middle Name

Last Name*

Date of Birth (dd/mm/yyyy)*

Patient Ontario Health Card Number or Medical Record Number*

I don't know my MRN, what should I do?

Address Line 1*

Address Line 2

City*

Province*

Postal Code*

Patient Email Address*

Patient Phone Number* (no spaces or dashes)

Signature

By clicking "Submit", I agree to the use, disclosure and sharing of personal and personal health information through the MyChart portal and I understand and agree to Terms and Conditions related to MyChart and the release of information which is available here. A copy of these Terms and Conditions will also be provided to you upon request.

Patient Consent (Type Full Name)

CHEO Patient Request