Authorization to Treat a Minor - Everett Clinic 2026

1. Click ‘Get Form’ to open the Authorization to Treat a Minor in the editor.
2. Begin by filling in the minor's name in the designated space. This ensures that the consent is specific to your child.
3. Indicate whether the minor is covered by health insurance by checking the appropriate box. If they are covered, provide details such as the Health Insurance Company Name, Phone, Policy Number, and Group Number.
4. In the section for parental consent, both parents or guardians should sign and date where indicated. Ensure that you include your Social Security numbers for verification purposes.
5. Finally, upload a copy of your insurance card (front and back) directly through our platform for easy submission.

Start using our platform today to complete your Authorization to Treat a Minor form quickly and efficiently!