Name: | DOB: | MRN: | PCP:

Activation Code Request

Welcome! Reliant Medical Group is pleased to offer this online request service for your MyChart activation code. Your activation code will be your key to accessing your personal and secure online health connection. Please fill out all required fields (*) to verify your MyChart enrollment.

If you already have an active MyChart account and have forgotten your ID or password please return to the log in page and click on the “Forgot MyChart ID” or “Forgot Password” which are located under the login boxes to retrieve the information.  For additional assistance please contact us at mychart@reliantmedicalgroup.org  or 774-261-1292.

*Affidavit:

We will email your activation code to the email address above after validating your submission with your Reliant Medical Group patient information. Should we have any questions regarding your submission, we will contact you via email.