Get Mychart Polyclinic

This guide provides a step-by-step approach to completing the MyChart Polyclinic access agreement online. Follow these instructions to ensure that all necessary information is accurately filled out, facilitating your access to MyChart services.

Follow the steps to successfully complete the MyChart Polyclinic online access agreement.

1. Press the ‘Get Form’ button to acquire the access agreement document. This will enable you to open the necessary form for completion.
2. Fill in your personal information clearly in the designated fields. This includes entering your full name, any previous names, the last four digits of your Social Security Number, and your date of birth.
3. Next, provide your mailing address, including the city, state, and zip code. Ensure that this information is complete and accurate.
4. Input both your home and work phone numbers where indicated. This allows the clinic to contact you for identity verification, as necessary.
5. Review the Access to Protected Health Information statements carefully. Make sure you understand and agree to each point before proceeding.
6. Sign and date the document at the bottom. Your signature indicates that you have read, understood, and agree to the terms outlined in the form.
7. After completing the form, prepare it for submission by mailing it along with your authorization agreement to the Polyclinic at the specified address. Ensure that you have the correct postage and send it to: The Polyclinic, Attn: EHR/MyChart, 1145 Broadway, Seattle, WA 98122.

Complete your MyChart access agreement online today to gain quick and secure access to your healthcare information.