MyChart - Online Scheduling

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Patient Information

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Patient

First Name

Middle Name

Last Name

Date of Birth

Legal Sex

Female Male Unknown Other

Social Security number

Address

Address line 2

City

State

ZIP Code

Home Phone

Mobile Phone

Insurance Information

Indicates a required field.

Insurance

Insurance Name

Member ID

Subscriber ID

Group Number

Subscriber Name

Subscriber Date of Birth

Who will be paying for the costs not covered by insurance?
If you are a current patient, please select who receives your billing statements.

Patient Someone Else

Verification

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Error: First name is required.

Error: Middle name is required.

Error: Last name is required.

Error: Name contains invalid characters.

Error: Spouse's last name is required.

Error: Spouse's last name first is required.

Error: Last name prefix is required.

Error: Spouse's last name prefix is required.

Error: Name suffix is required.

Error: Given name initials are required.

Error: Date of birth is required.

Error: Date of birth is invalid.

Error: Date of birth must be in the past.

Error: Legal sex is required.

Error: Email address is required.

Error: Email address is invalid.

Error: Home phone is required.

Error: Phone number is invalid.

Error: Mobile phone is required.

Error: Phone number is invalid.

Error: Work phone is required.

Error: Phone number is invalid.

Error: Address is required.

Error: City is required.

Error: County is required.

Error: Please enter a county.

Error: District is required.

Error: Please enter a district.

Error: House number is required.

Error: State is required.

Error: Please enter a state.

Error: ZIP code is required.

Error: Zip code is invalid.

Error: Country is required.

Error: Please enter a country.

Error: Social Security number is required.

Error: Social Security number is invalid. The correct format is NNN-NN-NNNN.

Error: Social Security number is required.

Error: Insurance is required.

Error: Insurance name is required.

Error: Member ID is required.

Error: Subscriber ID is required.

Error: Subscriber name is required.

Error: Subscriber date of birth is required.

Error: Subscriber date of birth is invalid.

Error: Subscriber date of birth must be in the past.

Error: Group number is required.

Error: Must be exactly 4 characters.

Error: Cannot exceed 18 characters

Error: Cannot exceed 20 characters

Error: Cannot exceed 25 characters

Error: Cannot exceed 40 characters

Error: Cannot exceed 50 characters

Error: Something went wrong while processing your request. Please check your information for any obvious errors and try submitting it again. If that doesn't work, contact us for help.

Error: That username is not available

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Error: The retyped password doesn't match the original.

Error: Your username must be between @MYCHART@MINLEN@ and @MYCHART@MAXLEN@ characters.

Error: Your username must have at least 3 characters.

Error: Your username cannot contain any spaces or symbols other than a period (.), hyphen (-), underscore (_), or the at symbol (@).

Error: That username is in use already.

Error: Your password must contain at least one letter and one number.

Error: Invalid password. Please enter a different password.

Error: Your password must have at least 2 characters.

Error: Your password must be between @MYCHART@MINLEN@ and @MYCHART@MAXLEN@ characters.

Error: Your password must be different than your username.

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Welcome to online scheduling, where you can schedule an appointment in just a few quick clicks. If you are experiencing an emergency, please do not use online scheduling. Call 911.

Online scheduling is available to both new and current patients for the services below. Additional services and providers not listed below may also offer online scheduling to existing patients they have seen within the past two years through My Sanford Chart.