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SickKids Parent/Legal Guardian (Proxy) Access - Under 12

MyChart is a secure portal that connects patients and families with your provider via the MyChart App or the online portal. It offers useful information such as upcoming appointments, most lab  and imaging test results, different types of visit summaries and much more!

Proxy access automatically expires when the patient reaches the age of 12 and 16 and requires a new application to reactivate.

Apply for access now by submitting this form.

All fields marked with a * are required.

Patient Information
 
Proxy Information (e.g. Parent, Legal Guardian)
Relationship to Patient*
Signature
By clicking "Submit", I agree to the use, disclosure and sharing of personal and personal health information through the MyChart portal and I understand and agree to Terms and Conditions related to MyChart and the release of information and proxy designation (if applicable) which is available here. A copy of these Terms and Conditions will also be provided to you upon request.
These documents are confidential and are for the sole use of the intended recipient. Any unauthorized use, disclosure or distribution is prohibited. If you mistakenly receive these documents please destroy and contact the sender immediately. This page was printed on Thursday 26 November 2020 at 6:04:32 PM.