Seattle Children's MyChart -

Thank you for your interest in Seattle Children's MyChart, a free application where you can access your medical record. Learn More

This form is for a patient, 13+ years old, to request their own MyChart account. Features available are limited for patients that are 13-17 years old.

If you are the parent or legal guardian of a Seattle Children's patient under the age of 18, complete Request MyChart Access to your Child's Record.
If you are a Children's Health patient over the age of 18 requesting access to your own record, complete Request MyChart Access to Your Record:

We will contact you if we have questions. Please note to check your email account’s spam folder.

Request MyChart Access to your Child's Record

Request MyChart Access to Your Record

Items marked with an * are required for this section.

Your First Name:

Your Middle Initial:

Your Last Name:

Your Date of Birth (mm/dd/yyyy):

Address:

City:

State:

Zip Code:

Phone (xxx-xxx-xxxx):

Email Address:

Comments:

PLEASE READ AND CERTIFY

By clicking below, I acknowledge that I have read, understand and agree to Seattle Children's MyChart terms and conditions. By signing as a patient, I represent that I am over 13 years of age and would like my own access to MyChart.

I Certify:

Yes

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