MyHealth OnLine registration for UPMC for Kids members

Please complete this form to request MyHealth OnLine access for your child. If you have multiple children enrolled with UPMC for Kids, you will need to register each child. Fill out and submit the form once for each child.

Once you submit the form, your request will be reviewed within two business days and you will then receive an email with additional log-in instructions.

Required fields are marked with an *

Parent/Guardian first name*

Parent/Guardian last name*

Parent/Guardian date of birth (MM/DD/YYYY)*

Address 1*

Address 2

City*

State*

ZIP code*

Phone*

Email*

Confirm email*

Child first name*

Child last name*

Child date of birth (MM/DD/YYYY)*

Child member ID*

By clicking “Submit”, you agree to our Terms and Conditions and Terms of Use and ask us to review your submitted form.

MyHealth OnLine registration for UPMC for Kids members

Parent / Guardian Information

Child Information

Account Information