Everett clinic records 2026

1. Click ‘Get Form’ to open the everett clinic records in the editor.
2. Begin by filling out the PATIENT INFORMATION section. Enter your name, date of birth, and social security number as required.
3. In the INFORMATION TO BE RELEASED FROM section, provide the name and address of the facility or provider releasing your medical records.
4. Next, complete the INFORMATION TO BE SENT TO section. Fill in the designated recipient's name, address, city, state, zip code, and fax number if applicable.
5. Indicate whether you want to release information to an active MyChart account or through a secure portal by checking 'Yes' or 'No' and initialing accordingly.
6. Select what information you wish to be released by checking one of the options provided under INFORMATION TO BE RELEASED.
7. Specify the purpose for which this disclosure is being made by checking one of the options listed.
8. Read and understand your rights regarding this authorization before signing at the bottom of the form. Ensure you include today's date.

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