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upload your photo ID



As part of your enrollment process, please upload an image of your driver's license or a valid photo ID to the form below (important: please return to the MyKidsChart form after uploading to complete your enrollment)

Our care team will validate your identity within 72 hours and complete your MyKidsChart registration. After our team completes your registration, your photo ID will be stored securely in our medical records system. It will not be stored on our website. If you have any questions or concerns, feel free to send us a message or call 937-641-3395.




One file only.
8 MB limit.
Allowed types: gif, jpg, jpeg, png.