Please use the form below to report a MyChart issue to our IT team. Thank you!If you are experiencing a medical emergency, please call 911. MyChart Issue Reporting Form***Note: If you need immediate assistance regarding an appointment, medical records, or lab results, please call one of our clinics directly.Please complete all required fields below and click Submit when done. A member of our MyChart support team will reach out to you within 3 business days (please note that multiple or repeated submissions may cause unnecessary delays in response times).---PATIENT DETAILS---First name*Enter patient's first name.Last name*Enter patient's last name.Email*Enter patient's email address that is associated with their MyChart account.Phone*Enter patient's primary phone number.Birthdate*Please enter the patient's birthdate in mm/dd/yyyy form.Primary Care Provider*Enter the last name of the patient's Primary Care Provider (PCP).---ISSUE DETAILS---Select topics that describe the MyChart problem that the patient is experiencing (select all that apply).* Password issue Error when logging in Incorrect patient information Unable to reach log in screen Other (provide details in 'Problem Description' section)Problem Description*Please provide a description of the problem that the patient is experiencing with MyChart. Please include any error messages - you may provide screen shots of errors in the 'Supporting Documents' section, if available.Upload Supporting DocumentYou may upload a supporting document related to the MyChart issue you are reporting, for example, a screen shot of an error you are receiving.Submit
