Service Specific Forms
If you are requesting your medical records be released to or from our clinic, please fill out the corresponding release form.
A parent/legal guardian must attend a minor’s first visit at Bastyr Center for Natural Health. For parents or legal guardians who cannot be present for subsequent visits, please fill out this form: Permission to Treat a Minor Without a Parent/Guardian Present.
To sign up for access to your child's MyChart record (children 11 and younger), please complete this form: Parental/Guardian Proxy Access to a Child's MyChart Record and email to firstname.lastname@example.org. Include Photo ID which is required to activate proxy. Please note that your child’s chart will be accessed through your MyChart record.
For any patient 12 and older that would like a parent or a legal guardian to access their MyChart account, please complete this form: Teen-Adult Guardian Proxy Access to MyChart and email to email@example.com.
Ready to get started on your journey to health and wellness? Contact us to ask questions and get your first appointment scheduled. Bastyr proudly offers telemedicine and in-person appointments.