Akron Children's Adult Patient MyChart Enrollment Form

Thank you for your interest in MyChart at Akron Children's Hospital. You are just a few steps away from secure, 24/7 access to your health information.

To sign up for access, please complete and submit the following form for approval. Once your request has been received, we will send a secure, activation email within 7 business days. We will contact you by phone or email if we have any questions.

Note: * indictates required field on the form.

Adult Patient Information

Requesting Access for:


I am an adult patient who is 18 or older of Akron Children's Hospital. All information I have provided is correct. By signing this form, I acknowledge that I am requesting access to my own MyChart account according to Akron Children's Hospital terms and conditions.

Click the statement to the right to sign this form electronically (It will turn blue when clicked):