New patients should print and fill out the following forms ahead of your first appointment:
Medical/Dental Appointment Forms
Behavioral Health Appointment Forms
New Patients: Please be advised, Equitas Health providers do not prescribe controlled substances for new patients nor do we manage chronic pain issues. If you are experiencing chronic pain problems, your Equitas Health provider will refer you to a specialist outside of our system or will help you explore alternative methods of managing pain.
Current patients have access to their accounts through MyChart. MyChart allows you to send messages to your doctor, view appointments, get information about your medications or conditions, renew your prescriptions, schedule appointments, and more.
Equitas Health’s version of MyChart is available to us through a partnership with Premier Partners.
First time signing in with MyChart? Follow these instructions:
- In your internet browser go to: www.premiermychart.com
- Click on the SIGN UP NOW link in the ‘Sign In’ box. You will see the New Member Sign Up page.
- Enter your MyChart Access Code exactly as it appears in your medical documents you received at your first appointment. You will not need to use this code after you’ve completed the sign-up process.
- When asked for the last 4 digits of your Social Security number, please enter all zeros (0000). If the system will not accept the zeros, then enter the last 4 digits of your social security number.
- Next enter your date of birth (mm/dd/yyyy), and then click SUBMIT. You will be taken to the next sign-up page.
- Create a MyChart ID. This will be your MyChart login ID and cannot be changed, so think of one that is secure and easy to remember.
- Create a MyChart password. You can change your password at any time.
- Write down your MyChart ID and password so you do not forget it. Store in a secure place.
- Enter your Password Reset Question and Answer. This can be used at a later time if you forget your password.
- Enter your e-mail address. You will receive e-mail notifications when new information is available in MyChart.
- Click SIGN UP.
You can now view your MyChart medical record. If you experience problems accessing your MyChart account, please contact Technical Support at (866) 668-0592. Remember, MyChart is NOT to be used for urgent needs. For medical emergencies, dial 911.
Any questions regarding billing should be directed to firstname.lastname@example.org.