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All information entered below should be as it appears on your last statement.

Accounts that have a balance of $0.00 are not currently available online.

Do you have a new statement with an all numeric account number that looks like this?

If so please go to our new MyChart website at https://mychart.chsli.org to access your account and make payments.

  *All Fields are Required
Patient Information
*Patient First Name:

*Patient Last Name:
*Patient Date of Birth: (mm/dd/yy)
Visit Information
*Account Number:
Enter the account number using the letter at the beginning and the following 10 digits. Do not include any dashes or other punctuation.
Contact Information
*Email Address:
*Email Confirm:
     
  I have read the "Notice of Privacy Practices" and agree to the use and disclosure of information as stated in the document.
  Having trouble logging on, or have other questions? Please call us at 1-888-681-1751.
 
 
 
     

Good Samaritan Medical Center