Proxy Access

To grant/request access to another patient or your child’s information on MyChart, please follow the steps listed below to submit your proxy access request:

  1. Download the MyChart Proxy Access Form here
  2. Complete the form and return to any Montage Health facility.
    1. Adults granting access to their MyChart must be present with a valid form of identification, such as a driver’s license.
  3. Drop off the signed paper form at any Montage Health location (please make sure to bring a valid form of photo ID, such as your driver’s license).

Once you have submitted the form, please allow 5-10 business days for processing. If your request is authorized, you will be notified via MyChart of your newly granted proxy access.

If you have any questions regarding the status of your submitted form, please contact (831) 625-4575.