SERVICES WAYS TO HELP FOR FAMILIES OUR TEAM MAKE APPOINTMENT CONTACT DONATE RECORDS REQUEST How to Request Records from Boyer Children’s Clinic Call our clinic at (206) 325-8477, or fill out the form below to request a copy of your child’s Boyer records. Please allow time after your child’s appointment for reports to be written. We will try to honor requests for records in 48 business hours when possible, and never longer than 15 working days. We keep a summary record of the services we provide your child. We will retain these records for at least seven years. If you have questions about records from other facilities, you need to request them from that facility. Our team will contact you using the contact information entered in the form below. If the contact information does not match the records in Boyer’s system, our team will ask you to provide previous contact information (mailing address, email address, or phone number) to verify your identity, before processing the request. We will not disclose your child’s record to others unless you give us a written Authorization for Boyer Children’s Clinic to Use or Disclose Protected Health Information form to do so or unless the law authorizes or compels us to do so. Access the Authorization form here: English Spanish Mail completed Authorization forms to: Boyer Children’s Clinic Attn: Records Requests 1850 Boyer Avenue East Seattle, WA 98112 You may also fax completed forms to (206) 323-1385, attn: Records Requests. Parent Name(s)* Parent Email* Parent Phone* Child Name* Child Date of Birth* How to send records? Secure e-mail Fax USPS Record types Evaluations IFSP All Medical Records Other (please specify in Additional information text box below) Additional information Attach completed authorization (ROI) form You may download the authorization form (PDF links above), complete the form, scan or take a digital photo of it, and attach it here. Accepted file types: pdf, jpg, png, . E-mail info@boyercc.org Phone (206) 325-8477 Fax (206) 323-1385 Montlake Clinic 1850 Boyer Ave. E. Seattle, WA 98112 Directions • Map Magnuson Clinic 7821 62nd Ave. NE, Suite 202 Seattle, WA 98115 Directions • Map If your family needs transportation to or from Boyer Children’s Clinic, we can help. Please email us at info@boyercc.org, call (206) 325-8477, or speak with your Family Resources Coordinator for more details. FOLLOW US (206) 325-8477 (206) 323-1385 info@boyercc.org www.boyercc.org MONTLAKE CLINIC 1850 Boyer Ave. E. Seattle, WA 98112 Directions MAGNUSON PARK CLINIC 7821 62nd Ave. NE Suite 202 Seattle, WA 98115 Directions Home Contact Us Donate Careers Our Story Programs & Services Family Resources Ways to Help Our Team Copyright © 2017 Boyer Children's Clinic