Everett Clinic My Chart


(4.7 / 5) 89 votes

Get your Everett Clinic My Chart in 3 easy steps

  • 01 Fill and edit template Fill Everett Clinic My Chart
  • 02 Sign it online Sign Everett Clinic My Chart
  • 03 Export or print immediately Export Everett Clinic My Chart

What Is an Everett Clinic MyChart Child Proxy Form?

An Everett Clinic MyChart Child Proxy Form is a 2-page document a parent requires to see their child’s test results, make appointments, and get medicine refills in Everett Clinic. You need to sign in to your MyChart account if you’re a current patient.

Everett Clinic My Chart Form Screenshot

What do I need a MyChart Everett clinic child proxy form for?

  • You need this form as a parent to get access to your kid’s MyChart account;
  • To view your child’s health information stored in Everett Clinic;
  • To check the medicine refills of your kid, registered at Everett Clinic.

How to Fill Out the Everett Clinic MyChart Child Proxy Form

To fill out the Everett Clinic MyChart online blank, you don’t need to leave this page. Follow the steps below:

Step 1: Click on the blue “Fill this form” button. You will be redirected to a page with a fillable template.

Step 2: Use the “Add text” tool on the upper toolbar. Write your child’s name and date of birth in the table at the top of page 1.

Step 3: Write your name, address, e-mail, and phone number in the section “Parent/Guardian information”.

Step 4: Read the terms and conditions regarding access to your child’s account on pages 1−2 and sign the form.

Step 5: Put the current date.

Step 6: Save the changes by tapping the red Done button. Now you can download the document on your PC.

Organizations that work with a MyChart Everett clinic child proxy form

  • Everett Clinic

Fillable online Everett Clinic My Chart
(4.7 / 5) 89 votes
Please, wait...
We use unpersonalized cookies to keep our site working and collect statistics for marketing purposes. By continuing to use this site, you consent to this policy. Learn more