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if (InitialBodyClass) { InitialBodyClass.parentNode.removeChild(InitialBodyClass); } } else { top.location = "/MyChartPRD/Home/LogOut"; } </script>  <script nonce='7769f1d58d1244cd9cf39957ee4eff63' type="application/ld+json"> { "@context" : "https://schema.org", "@type" : "WebSite", "name" : "Vanderbilt University Medical Center", "url" : "https://myhealthatvanderbilt.com/Authentication/Login", "alternateName" : ["Vanderbilt University Medical Center My Health", "My Health", "VUMC My Health", "VUMC"]} </script> </head> <body class=" isPrelogin fullHeightPrelogin hasNoCommunityLinks color1 md_standalone_signup" > <div id="jsdisabled" class="overlay"><div class="lightbox_overlay"></div><div class="jsdisabled"><p><span class='clearlabel'>Error: </span>Please enable JavaScript in your browser before using this site.</p></div><script nonce='7769f1d58d1244cd9cf39957ee4eff63' type='text/javascript'>document.getElementById('jsdisabled').style.display = 'none';</script></div> <div id ="appPopupRoot" class="overlayContainer"></div> <div id = "classicPopupRoot" class="overlayContainer"> <div id = "onboarding-content" class="jqHidden"></div> <div id="lightbox" class="lb_content jqHidden"></div> <div id="lightbox_overlay" class="lightbox_overlay lb_overlay jqHidden" csp-guid-click="3a90eefa1f39406abc4c91660dbf9be3"></div> </div> <div id="wrap" data-hide-during-popup="true"> <div class='hidden' id='__CSRFContainer'><input name="__RequestVerificationToken" type="hidden" value="ydomBIF_Ulf5wqLWPXblJkAqgxc1o0KinsGgrcrfUL5dyDLJqf_eXVnqIQDg-Y_Xuh_TcpcZldKpeAgpUPVExSKB5dE1" /></div> <div id="toastWrapper" class="fitme width animToast" role="status" aria-live="polite" aria-atomic="true"></div> <div id="content" class="hasSidebar"> <main id="main"> <a href="/MyChartPRD/" class="logo" title="" aria-label="My Health - Your secure online health connection"></a> <div class="title"> <h1 class="header"> Sign Up <span class="subjectIndicator"></span> </h1> </div> <div id="signup-workflow"> <div id="Signup_subway" class="hidden"></div> <div id="OriginalAppointmentInfoHost"></div> <div class="card helptip hidden">There were some errors found in the form. Fix these errors and submit again.</div>  <div id="Signup_demographics" class="onlineSignupContainer hidden"> <div id="SignupDemographic_Container" class="demographics-form-container"> <div class="section"> <div class="content"> <h2 aria-live="polite" class="header hidden formTitle">Patient Information</h2> <div id="pretextdemogInBasket" class="pretextcontainer" aria-live="assertive"><p class="pretext"><p>In order to keep your health information private and secure, we will need to confirm that the person setting up your account is really you. To do this, we use a third-party service to confirm your identity with questions drawn from your credit history. This company does NOT receive or have access to any of your health information. This also will NOT affect your credit score. However, you may see the inquiry listed on your credit report as EXPERIANHLTH/VANDERBILT.</p> <p>You may also sign up for a My Health at Vanderbilt account in person at your next visit. </p> <p>If you have questions, call us at 615-343-HELP (4357)</p> <h2 class="header">Request Access to a Dependent or Spouse's Health Information</h2><ul style=" list-style: disc; list-style-position: inside; ">If you need access to the health information of a...<li style=" list-style-position: inside; ">child or other diminished capacity/dependent adult <a href="https://www.vanderbilthealth.com/information/requesting-proxy-access " target="_blank"">click here</a></li> <li>Spouse or other adult <a href="https://www.vanderbilthealth.com/information/view-and-change-account-settings " target="_blank"">click here</a></li></ul></p></div> <div id="pretextdemog2FASignup" class="pretextcontainer" aria-live="assertive"><p class="pretext">Follow these steps to sign up for a My Health account.<ul class='bulleted'><li>Enter your personal information.</li><li>Verify your contact information.</li><li>Choose a username and password.</li></ul><p>If you have any questions, please contact us at <span dir='ltr'><a href='tel:615343'>(615) 343</a>-HELP (4357)</span>.</p></p></div> <div id="pretextdemogPatientChoice" class="pretextcontainer" aria-live="assertive"><p class="pretext">Follow these steps to sign up for a My Health account.<ul class='bulleted'><li>Enter your personal information.</li><li>Verify your identity.</li><li>Choose a username and password.</li></ul><p>If you have any questions, please contact us at <span dir='ltr'><a href='tel:615343'>(615) 343</a>-HELP (4357)</span>.</p></p></div> <div id="pretextthirdparty" class="pretextcontainer" aria-live="assertive"><p class="pretext"><p>In order to keep your health information private and secure, we will need to confirm that the person setting up your account is really you. To do this, we use a third-party service to confirm your identity with questions drawn from your credit history. This company does NOT receive or have access to any of your health information. This also will NOT affect your credit score. However, you may see the inquiry listed on your credit report as EXPERIANHLTH/VANDERBILT.</p> <p>You may also sign up for a My Health at Vanderbilt account in person at your next visit. </p> <p>If you have questions, call us at 615-343-HELP (4357)</p> <h2 class="header">Request Access to a Dependent or Spouse's Health Information</h2><ul style=" list-style: disc; list-style-position: inside; ">If you need access to the health information of a...<li style=" list-style-position: inside; ">child or other diminished capacity/dependent adult <a href="https://www.vanderbilthealth.com/information/requesting-proxy-access " target="_blank"">click here</a></li> <li>Spouse or other adult <a href="https://www.vanderbilthealth.com/information/view-and-change-account-settings " target="_blank"">click here</a></li></ul></p></div> <div id="pretextguestpatient" class="pretextcontainer"></div> <div id="pretextguestproxy" class="pretextcontainer"></div> <div id="pretextopenscheduling" class="pretextcontainer"><p class="pretext"><div class="webonly"> <div class="osonly"> <div class="ossteps"> <div class="osinactive">Tell us more</div> <img src="en-us/images/arrow_right.svg" class="osimage"> <div class="osinactive">Appointment Time</div> <img src="en-us/images/arrow_right.svg" class="osimage"> <div class="osinactive">Review</div> <img src="en-us/images/arrow_right.svg" class="osimage"> <div class="osactive">Patient Information</div> <img src="en-us/images/arrow_right.svg" class="osimage"> <div class="osinactive">Confirmation</div> </div> </div> </div> <div class="mobileonly"> <div class="osonly"><h2>Patient Information</h2></div> </div> <br/>We need to collect some information about the patient in order to schedule this appointment. If you have any questions, please contact your clinic.<br/> <p style="padding-top: 10px;"><b>Please fill out the form below with the patient's information.</b></p></p></div> <div id="pretextScheduleForSomeoneElsePatient" class="pretextcontainer"></div> <div class="requiredInstructions" aria-hidden="true">Indicates a required field.</div> <p class="alert" id="DirectSignupError"></p> <p class="alert hidden" id="BadToken"></p> <form action="/MyChartPRD/Signup/Standalone/SubmitActivationRequest" autocomplete="off" id="SignupDemographic_Form" method="post"><input name="__RequestVerificationToken" type="hidden" value="ydomBIF_Ulf5wqLWPXblJkAqgxc1o0KinsGgrcrfUL5dyDLJqf_eXVnqIQDg-Y_Xuh_TcpcZldKpeAgpUPVExSKB5dE1" /> <div id="Demographic_Container" class="readOnlyAsPlaintext"> <fieldset class="demogSection" id="nameSection"> <legend><h2 class="header medium">Name</h2></legend> <div class="selfsignupName grid"> <div class="row"> <div class="col-4"> <div class="legacyLabelledField"> <label for="NameInput1" class="required ">First name</label> <input id="NameInput1" value="" data-name="NameInput1" name="NameInput" aria-required="true" class="name required withAutoComplete" autocomplete="given-name" data-validation-settings="{"required":true}" /> </div> <div class="hidden messagedisplay" id="NameInput1_message" aria-live="polite" data-message-display-for="NameInput1" ></div> </div> <div class="col-4"> <div class="legacyLabelledField"> <label for="NameInput2" class=" ">Middle name</label> <input id="NameInput2" value="" data-name="NameInput2" name="NameInput" aria-required="" class="name withAutoComplete" autocomplete="additional-name" data-validation-settings="{}" /> </div> <div class="hidden messagedisplay" id="NameInput2_message" aria-live="polite" data-message-display-for="NameInput2" ></div> </div> <div class="col-4"> <div class="legacyLabelledField"> <label for="NameInput3" class="required ">Last name</label> <input id="NameInput3" value="" data-name="NameInput3" name="NameInput" aria-required="true" class="name required withAutoComplete" autocomplete="family-name" data-validation-settings="{"required":true}" /> </div> <div class="hidden messagedisplay" id="NameInput3_message" aria-live="polite" data-message-display-for="NameInput3" ></div> </div> </div> </div> </fieldset> <fieldset class="demogSection" id="addressSection" data-required="1"> <legend><h2 class="header">Address</h2></legend> <div id="addressSectionRoot"> </div> </fieldset> <fieldset class="demogSection" id="otherSection"> <legend><h2 class="header medium">Other Information</h2></legend> <div class="grid"> <div class="row"> <div class="col-4"> <div class="legacyLabelledField"> <label for="DateOfBirth" class="required ">Date of birth</label> <input id="DateOfBirth" value="" name="DateOfBirth" class="DateOfBirth required" data-validation-settings="{"required":true,"isDate":true,"minDate":"1875-02-17","maxDate":"2025-02-17","isDOB":true}" /> </div> <div class="hidden messagedisplay" id="DateOfBirth_message" aria-live="polite" data-message-display-for="DateOfBirth" ></div> </div> </div> <div class="row"> <div class="formcolumn triple col-12"> <fieldset class="radioSection"> <legend class="fieldGroupPrompt required ">Legal sex</legend> <div data-required="1" data-name="Gender" id="Gender"> <span class="tbContainer"> <input class="togglebutton clearradio xsmall " id="legalSex0" name="Gender" type="radio" value="1" data-validation-settings="{"required":true}" /> <label class="togglebutton" for="legalSex0">Female</label> </span> <span class="tbContainer"> <input class="togglebutton clearradio xsmall " id="legalSex1" name="Gender" type="radio" value="2" data-validation-settings="{"required":true}" /> <label class="togglebutton" for="legalSex1">Male</label> </span> <span class="tbContainer"> <input class="togglebutton clearradio xsmall " id="legalSex2" name="Gender" type="radio" value="3" data-validation-settings="{"required":true}" /> <label class="togglebutton" for="legalSex2">Unknown</label> </span> </div> </fieldset> <div class="hidden messagedisplay" id="Gender_message" aria-live="polite" data-message-display-for="Gender" ></div> </div> </div> <div class="row"> <div class="col-4"> <div class="legacyLabelledField"> <label for="Last4SSN" class=" ">Last four digits of SSN</label> <input id="Last4SSN" type="password" inputmode="numeric" value="" name="Last4SSN" maxLength="4" class="Last4SSN withAutoComplete" autocomplete="new-password" data-validation-settings="{"maxLength":4}" /> </div> <div class="hidden messagedisplay" id="Last4SSN_message" aria-live="polite" data-message-display-for="Last4SSN" ></div> </div> </div> <div class="row"> <div class="col-4"> <div class="legacyLabelledField"> <label for="Email" class="required ">Email address</label> <input id="Email" type="email" value="" name="Email" class="Email required" data-validation-settings="{"required":true,"isEmail":true}" /> </div> <div class="hidden messagedisplay" id="Email_message" aria-live="polite" data-message-display-for="Email" ></div> </div> <div class="col-4"> <div class="legacyLabelledField"> <label for="EmailVerification" class="required ">Verify email address</label> <input id="EmailVerification" type="email" value="" name="EmailVerification" class="EmailVerification required" data-validation-settings="{"required":true,"isEmail":true}" /> </div> <div class="hidden messagedisplay" id="EmailVerification_message" aria-live="polite" data-message-display-for="EmailVerification" ></div> </div> </div> <div class="row"> <div class="col-4"> <div class="legacyLabelledField"> <label for="HomePhone" class="required ">Home phone</label> <input id="HomePhone" type="tel" value="" name="HomePhone" class="HomePhone required" data-validation-settings="{"required":true}" /> </div> <div class="hidden messagedisplay" id="HomePhone_message" aria-live="polite" data-message-display-for="HomePhone" ></div> </div> <div class="col-4"> <div class="legacyLabelledField"> <label for="WorkPhone" class=" ">Work phone</label> <input id="WorkPhone" type="tel" value="" name="WorkPhone" class="WorkPhone " data-validation-settings="{}" /> </div> <div class="hidden messagedisplay" id="WorkPhone_message" aria-live="polite" data-message-display-for="WorkPhone" ></div> </div> <div class="col-4"> <div class="legacyLabelledField"> <label for="MobilePhone" class=" ">Mobile phone</label> <input id="MobilePhone" type="tel" value="" name="MobilePhone" class="MobilePhone " data-validation-settings="{}" /> </div> <div class="hidden messagedisplay" id="MobilePhone_message" aria-live="polite" data-message-display-for="MobilePhone" ></div> </div> </div> </div> </fieldset> </div> <div class="formsection"> <input id="token" name="token" type="hidden" value="" /> <div id="CAPTCHA"></div> </div> <div id="posttextdemogInBasket" class="posttextcontainer"></div> <div id="posttextdemogPatientChoice" class="posttextcontainer"></div> <div id="posttextdemog2FASignup" class="posttextcontainer"></div> <div id="posttextthirdparty" class="posttextcontainer"></div> <div id="posttextguestpatient" class="posttextcontainer"></div> <div id="posttextguestproxy" class="posttextcontainer"></div> <div id="posttextScheduleForSomeoneElsePatient" class="posttextcontainer"></div> <div class="formbuttons multiStep"> <input type="submit" id="SignupDemog_buttonsubmit" name="Submit" data-disable-if-invalid value="Submit" class="button completeworkflow workflow" /> <input type="button" id="SignupDemog_buttonnext" name="Next" data-disable-if-invalid value="Next" class="button nextstep workflow" /> <input type="button" id="SignupDemog_buttonback" name="Back" value="Back" class="button previousstep secondary neutral hidden ensureRightAlignment" autocomplete="off" /> <input type="button" id="SignupDemog_buttoncancel" name="Start over" value="Start over" class="sm-only button startover cancelworkflow hidden" autocomplete="off" /> </div> <div id="SuccessMessageInBasket" class="hidden"> <div class="message"> <p>Thank you - your request has been sent to the clinic. You will receive an activation code in your mail or email within a week.<br /><br />If you have any questions or if you do not receive your activation code, call customer service.</p> <a href="/MyChartPRD/default.asp" class="button otherbutton autowidth">Back to Login Page</a> </div> </div> <div id="SuccessMessageInBasketFallback" class="hidden"> <div class="message"> <p>We were unable to verify your information, so your request has been sent to the clinic. You will receive an activation code by mail or email within a week.<br /><br />If you have any questions or if you do not receive your activation code, call customer service at <span dir='ltr'><a href='tel:615343'>(615) 343</a>-HELP (4357)</span>.</p> <a href="/MyChartPRD/default.asp" class="button otherbutton autowidth">Back to Login Page</a> </div> </div> <div id="FailureMessage_NoMessage" class="hidden"> <div class="message"> <p>We are experiencing technical difficulties at this time. Please try again later or contact our customer service line for assistance.</p> <a href="/MyChartPRD/default.asp" class="button otherbutton autowidth">Back to Login Page</a> </div> </div> <div id="FailureMessage_MessageSuppressed" class="hidden"> <div class="message"> <p>We were unable to verify your identity using the information provided. Please contact customer service at聽<span dir='ltr'><a href='tel:615343'>(615) 343</a>-HELP (4357)</span> for assistance.</p> <a href="/MyChartPRD/default.asp" class="button otherbutton autowidth">Back to Login Page</a> </div> </div> <div id="FailureMessage_WrongConfiguration" class="hidden"> <div class="message"> <p>We are experiencing technical difficulties at this time. Please contact our customer service line for assistance.</p> <a href="/MyChartPRD/default.asp" class="button otherbutton autowidth">Back to Login Page</a> </div> </div> <div id="FailureMessage_ExistingAccount" class="hidden"> <div class="message"> <p>There is an existing account for this person.<br /><br />From the login page, click "Forgot My Health Username?" or "Forgot Password?" to access this account.</p> <a href="/MyChartPRD/default.asp" class="button otherbutton autowidth">Back to Login Page</a> </div> </div> <div id="FailureMessage_InactiveExistingAccount" class="hidden"> <div class="message"> <p>There is an existing account for this person. <br /><br />Please contact us directly to restore access to your account.</p> <a href="/MyChartPRD/default.asp" class="button otherbutton autowidth">Back to Login Page</a> </div> </div> <div id="FailureMessage_Unknown" class="hidden"> <div class="message"> <p>We are experiencing technical difficulties at this time. Please try again or contact our customer service line for assistance.</p> </div> </div> <div id="FailureMessage_UnableToSignup" class="hidden"> <div class="message"> <p>Unable to complete My Health signup. 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