My wake health 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the required information about the minor patient. Enter their last name, first name, middle name, date of birth, and either the last four digits of their social security number or their WFBMC medical record number.
3. Next, provide the street address, city, state, and zip code for the minor patient.
4. Now, move on to the parent/legal guardian section. Fill in your last name, first name, middle name, date of birth, and either the last four digits of your social security number or your WFBMC medical record number.
5. Complete your street address, city, state, zip code, phone number with area code, and email address.
6. Specify the expiration date for this authorization. It can be a specific date or one year from your signature.
7. Finally, sign and date the form to affirm that you are the custodial parent and that your parental rights have not been revoked by a court of law.

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