We need some information from you in order to grant you a MyCooper account. After submitting this form, you will automatically be directed to your new account. If you need assistance, please call the MyCooper Support desk at 1-844-369-2667.

FOR NEW ACCOUNTS ONLY: This form is for new accounts. Only one request per patient is permitted. If you have an existing account and do not remember your login or password, use the Forgot Username or Forgot Password links for assistance (or contact the MyCooper Support desk at 1-844-369-2667 or email mycoopersupport@cooperhealth.edu). All other updates to your personal information must be made in person in the office.

IMPORTANT: You must be 12 years and older to access online activation. Patients under the age of 12 are not eligible for their own MyCooper account.

PLEASE NOTE: If you do not have separate home and mobile phone numbers, please enter your primary number in both fields.

We need some information in order to grant you a MyCooper account. Enter your demographics here and in the next step we will verify your identity using questions from a third-party verification system. When you're approved, you will receive an email or a letter with your activation code and instructions on how to activate your MyCooper account. If you have any questions, please contact your clinic.

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First, we need to collect some information about the patient. If you have any questions, please contact us at 1-844-369-2667.

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Now, we need to collect some information about you. After you submit the request, we will set up your appointment. If you have any questions, please contact us at 1-844-369-2667.

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We need to collect some information about the patient in order to schedule this appointment. If you have any questions, please contact your clinic.