Please Identify Yourself

Step 1 of 3

All fields are required.
*Please contact Beaumont Registration at 1-855-577-5780 if you have Social Security Number or Date of Birth errors*

myBeaumontChart Activation Code

Enter your Activation Code as it appears on your enrollment letter (your code is not case sensitive). You will not need to use this code after you complete the signup process.

xxxxx
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xxxxx
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xxxxx

Please enter the last 4 digits of your Social Security Number.  

nnnn
Date of Birth

Enter your date of birth in the format shown, using 4 digits for the year.  

mm
/
dd
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yyyy