Name: | DOB: | MRN: | PCP:

Sign Up For Access To Your Own Medical Records

If you are a Marshall Medical patient:
Please enter your contact information below to receive access to your own medical record. An enrollment letter containing your MyChart Activation Code and instructions on how to proceed will arrive via e-mail. Please allow two business days to receive your Activation Code.

Do not use this form to request access to a family member's chart. Please click the following link for additional information on how to request access to a chart which is not your own. How To Obtain Access To A Family Member's Chart

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.

Help with Medical Record Number

Complete Date of Birth is Required, submissions without DOB will not be processed

Terms and Conditions