MyChart - Signup

DDM Home Complete the information below in order to receive your MyChart access code. Once approved, you will receive an email with your activation code and instructions on how to activate your MyChart account. If you have any questions, please call 216-778-8801.

Adults age 18 and older can request an activation code online. For patients under age 18, please print this form and bring it to you or your child's next appointment.

We need some information in order to grant you a MyChart account. Enter your demographics here and in the next step we will verify your identity using questions from a third-party verification system. Once verified, 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, please contact your clinic.

Indicates a required field

Name

First name

Middle name

Last name

Address

Address information is required.

AddressCityStateZIPCountyCountry

Address	City	State	ZIP	County	Country
__Street__	__City__	__State.Title__	__Zip__	__County.Title__	__Country.Title__

Other Information

Date of birth

MM/DD/YYYY

Home phone

NNN-NNN-NNNN

Last four digits of SSN

NNNN

Medical record number

Email address

Verify email address

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Request an Activation Code for MyChart

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