Get Mychart Patient Access Request Form

The MyChart Patient Access Request Form is a crucial document that allows users to gain secure access to their health records. This guide will provide comprehensive, step-by-step instructions on completing the form online, ensuring a smooth and efficient process for all users.

Follow the steps to successfully fill out the MyChart Patient Access Request Form

1. Click ‘Get Form’ button to obtain the form and open it in an online editor.
2. Begin by filling in the Patient Information section. Include your last name, first name, middle initial, health card number, and date of birth (formatted as yyyy/mm/dd).
3. Indicate your gender and provide your current street address, city, province, and postal code.
4. List your phone numbers, including both home and cell contacts, and provide an email address for further communication.
5. If the patient is 12 years or older, enter their name and signature. If the patient is under 12 years of age, include the legal guardian's name and signature in the designated area.
6. Fill in the date section (formatted as yyyy/mm/dd) for when the form is completed.
7. After ensuring all fields are correctly filled out, save any changes made to the form in the online editor.
8. Options will be available for you to download, print, or share the filled form with the appropriate Health Records Department at the healthcare institution.

Complete your MyChart Patient Access Request Form online today for efficient access to your health records.