MyNovant
 

Activation Code

If you have already received an activation code, please do not fill out this form. Instead, click the I have an activation code button on the homepage to generate your username and password.

In order to receive an activation code required for the creation of a MyChart account, we must first gather some information from you to verify your identity. Please fill out the form below in its entirety and press Send when complete. You will receive an email at the address you list, provided it matches our existing records, within three business days. If your email does not match what we have on file, your activation code will be mailed to your home address.

*Please note that this form is for personal use only and cannot be used to request a MyChart account for a family member. To receive proxy access, please contact your physician’s office.
First Name
Last Name
Address
City
State
Zip Code
Phone Number
Email Address
Date of Birth
SSN (Last four digits)
Choose Your Practice Location:
Physician Name (optional):
First, Last