MyChart - Sign Up

We need some information to grant you a MyChart account. After you submit this request, it may take up to a week for processing and verification. When you're approved, 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 us at 812-450-4357.

Follow these steps to sign up for a MyChart account.

Enter your personal information.
Verify your contact information.
Choose a username and password.

If you have any questions, please contact us at 812-450-4357.

Follow these steps to sign up for a MyChart account.

Enter your personal information.
Verify your identity.
Choose a username and password.

If you have any questions, please contact us at 812-450-4357.

Follow these steps to sign up for a MyChart account.

Enter your personal information.
Verify your identity.
Choose a username and password.

If you have any questions, please contact us at 812-450-4357.

First name

Middle name

Last name

Medical record number

Date of birth

Mobile phone

Home phone

Work phone

Email address

Verify email address

Last four digits of SSN

Legal sex

Female Male Unknown Other

I agree that by clicking on the NEXT button immediately following this notice, you are providing “written instructions” to Deaconess or a Deaconess affiliate under the Fair Credit Reporting Act authorizing Deaconess or a Deaconess affiliate to obtain information from your personal credit profile or other information from Experian. You Authorize Deaconess or a Deaconess affiliate to obtain such information solely to verify your identity.

If you choose not to continue, please contact your provider’s office to receive an activation code.

The questions on the following page are from a third-party system. Questions from your credit profile will be used to confirm your identity. This process will NOT access your credit or affect your credit rating, and your provider or hospital will not see or save this information. Once you have successfully confirmed your identity, you will be able to setup your MyChart account.

Sign Up

Name

Address

Other Information

Sign Up

Patient Information

Name

Address

Other Information

Unable to Verify Your Identity

Unable to Verify Your Identity