MyChart -

You may request a MyChart account if your physician’s department appears in the Department visited: drop down menu.

Complete the form below in it's entirety, and submit the request. We'll send you your access code and registration instructions via e-mail.

Are you a Baylor Medicine employee?

YesNo

Department Visited:

First Name:

Last Name:

DOB(xx/xx/xxxx):

Address:

City:

State:

Zip Code:

Home Phone(xxx-xxx-xxxx):

Email Address:

Your Physician:

MyChart Access Request