Follow the steps to fill out the GA Wellstar MyChart 1664 form online.

1. Click the ‘Get Form’ button to access the GA Wellstar MyChart 1664 form and open it in your chosen editor.
2. Begin by entering your personal information in the 'Parent / Guardian Information' section. Clearly print your name including your last name, first name, and middle initial. Optionally, you may provide your social security number.
3. Fill in your street address, city, state, zip code, and email address. Include your primary physician's name and your date of birth.
4. Next, address the child or children for whom you are requesting proxy access. Fill out all required fields for each child, including their name (last, first, and middle initial), optional social security number, primary physician, and date of birth. If you have more than four children, obtain additional forms if necessary.
5. Review the MyChart terms and conditions carefully. By signing, you acknowledge that you understand your responsibilities regarding account security and access limitations.
6. Make sure to sign the form where indicated. Include your relationship to the child and the date of your signature.
7. Once the form is completed, you can email it to mycharthelp@wellstar.org or fax it to 770-999-2306. If you need assistance, do not hesitate to call the MyChart Help Desk at 470-644-0419.

Complete the GA Wellstar MyChart 1664 form online today to gain access to your child's medical records.