Mychart dupage 2025

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4.6 out of 5

51 votes

The document is a sign-up form for MyChart, an online tool provided by DuPage Medical Group that allows patients to access their health information securely. It includes instructions for completing the form, necessary personal information required, and terms and agreements regarding the use of MyChart. Patients are informed about the confidentiality of their medical information and the responsibilities associated with maintaining account security.

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Click ‘Get Form’ to open the mychart dupage Sign-Up Form in the editor.
Begin by filling out your personal information. Clearly print your name (last, first, middle initial), date of birth, last four digits of your Social Security Number, email address, street address, city, state, zip code, and phone number.
Indicate your primary physician by selecting from the provided options or entering their name if not listed.
Review the MyChart Terms and Agreement carefully. Ensure you understand each point regarding confidentiality and responsibilities before proceeding.
Sign and date the form at the bottom to acknowledge that you have read and agree to the terms outlined in the MyChart Sign-Up Form.
Once completed, return the form to your clinic or send it to DuPage Medical Group's HIM Department as instructed.

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Versions	Form popularity	Fillable & printable
2012	4.6 Satisfied (51 Votes)

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