Follow the steps to fill out the form accurately

1. Click 'Get Form' button to obtain the form and open it.
2. Begin by filling out the required information about the minor patient. This includes their last name, first name, middle name, date of birth in mm/dd/yyyy format, and either the last four digits of their social security number or their Wake Forest Baptist Medical Center medical record number. Additionally, provide their street address, city, state, and zip code.
3. Next, complete the required information about yourself as the parent or legal guardian. This section includes your last name, first name, middle name, date of birth in mm/dd/yyyy format, and either the last four digits of your social security number or your Wake Forest Baptist Medical Center medical record number. Please also include your street address, city, state, zip code, phone number with area code, and email address.
4. Indicate the expiration of the authorization by specifying a date, or select one year from the date of your signature.
5. Finally, affirm that you are the custodial parent by signing the form along with the date.
6. After completing the form, review your entries for accuracy. Save any changes made, and you may choose to download, print, or share the form as needed.

Complete the My Wake Health document online to ensure access to your child's health information.