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Patient Information

Do not use this form to request access to a family member’s chart. Once you have established an account, log in and visit "Request Family Access" for more information.

Improperly obtaining access to another's medical records without a valid patient authorization is against State and Federal confidentiality law and is subject to fines and/or imprisonment.

Follow these steps to sign up for a STH MyChart account.

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

If you have any questions, please contact us at (555) 555-5555.

Follow these steps to sign up for a STH MyChart account.

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

If you have any questions, please contact us at (555) 555-5555.

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Name

First name

Middle name

Last name

Address

Other Information

Date of birth

Legal sex

FemaleMaleUnknown

Home phone

Mobile phone

Email address

Verify email address

Last four digits of SSN

The last four digits of your SSN will not be stored. We use this to eliminate duplication, expedite service, and prevent identity theft.

Thank you - your request has been sent to the clinic. You will receive an activation code in your mail or email within a week.

If you have any questions or if you do not receive your activation code, call customer service.

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We were unable to verify your information. Please call 618-548-3194 to request a MyChart activation code.

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We are experiencing technical difficulties at this time. Please try again later or contact our customer service line for assistance.

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We were unable to verify your identity using the information provided. Please contact 618-548-3194 for assistance.

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We are experiencing technical difficulties at this time. Please contact our customer service line for assistance.

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There is an existing account for this person.

From the login page, click "Forgot username?" or "Forgot password?" to access this account.

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There is an existing account for this person.

Please contact us directly to restore access to your account.

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Ask the patient to resend the invitation.

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Unable to complete STH MyChart signup. Please contact customer service at (555) 555-5555 for help activating your account.

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