MyChart -

All fields with a * are required. This information is used to verify your identity with our system.

Questions about the MyChart Website: Fill out information below to ask a question or submit feedback about the MyChart Website. You may also call (585) 275-8762 (choose Option 1) or 1 (888) 661-6162 (choose Option 1) Monday through Friday, 8am-4:30pm.

Questions about Information in your Record: Please call your doctor's office, or send a message (you'll need to be logged into MyChart; then click on Messaging -> Ask A Question).

First Name*	Last Name*
Date of Birth (MM/DD/YYYY)*	Daytime Phone Number*
Email Address*	Current UR Medicine Physician or PCP*
I need help with:*
Address*	City*
State*:	Zip Code*
How can we help you?*

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