How to request access to your child's health information.

Proxy Home

Follow these steps:

  1. At your next clinic visit, please fill out a proxy access form and give to the staff. The form will be reviewed for accuracy. If Bellin has any questions regarding your proxy access form, the My Bellin Health Service Desk will contact you to resolve any questions that they may have.
  2. Once your form has been reviewed and processed by Bellin, you will receive an activation letter in the mail with an activation code.

If the above steps have been completed, answer the following question:

Did you receive your activation letter & code via mail?

Yes No

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