Request to Access a Minor's Record

Use this form to request MyChart access to a minor. Enter information about the minor to whom you are requesting access as well as information about yourself. All fields are required.

MyChart is currently available only for patients at the Greenville, Lexington, Shreveport, Portland, Medford, Chicago, Salt Lake City, Twin Cities, Erie, Springfield, Boston, Philadelphia, Ohio, Spokane, St. Louis, Texas, Pasadena, Sacramento, and Honolulu locations. Patients at all other Shriners facilities should continue to use the HealtheLife Patient Portal.

Your Information:

Minor Information:

The person you are requesting MyChart access to.