MyChart - Sign Up

We need some information from you in order to grant you a MyChart account. Once submitted, it could take up to a week for processing and verification. Once approved, you will receive an email or a letter with your activation code and instructions on how to activate your MyChart account. If you have any questions or prefer not to use this form, please contact the MyChart Help Desk at 805-898-3333.

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Follow these steps to sign up for a MyChart account.

Enter your personal information.

Verify your contact information.

Choose a username and password.

If you have any questions, please contact us at 805-898-3333.

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Follow these steps to sign up for a MyChart account.

Enter your personal information.

Verify your identity.

Choose a username and password.

If you have any questions, please contact us at 805-898-3333.

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We need some information in order to grant you a MyChart account. Submit your information below, and we'll check to see if it matches information on file. If a match is found, you can then follow the on-screen instructions to create your account. If a match is NOT found, Sansum Clinic will contact you within seven business days to help you create an account.

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First, we need to collect some information about the patient. If you have any questions, please contact us at 805-898-3333.

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Now, we need to collect some information about you. After you submit the request, we will set up your appointment. If you have any questions, please contact us at 805-898-3333.

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We need to collect some information about the patient in order to schedule this appointment. If you have any questions, please contact your clinic.

First name

Middle initial

Last name

Date of birth

Last four digits of SSN

Legal Sex

Female Male Unknown

Mobile phone

Email address

Verify email address

Sign Up

Name

Other Information