MyChart Family Access

You may request access to view information on your childrens medical record and communicate on their behalf in MyChart. Please select the authorization form below, fill it out, and return it to the address listed.

Send Completed Forms to:

MyChart Support
3524 E. Milwaukee St
Janesville WI 53546

Parent Accessing a Minor:    Fill out English form      Print in English      Print in Spanish

Adult Accessing an Adult:    Print in English      Print in Spanish