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.

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

IMPORTANT: You must be 18 years and older to access online activation. Patients between the ages of 12 and 17 must request a MyCooper account from their provider. Patients under the age of 12 are not eligible for their own MyCooper account.

We need some information in order to grant you a MyChart account. Enter your demographics here and in the next step we will verify your identity using questions from a third-party verification system. Once verified, you will receive an email or a letter with your activation code and instructions on how to activate your MyChart 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 your clinic.

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Now, we need to collect some information about you. Once we have this information, we will set up your appointment. If you have any questions, please contact your clinic.

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