Patient Forms

  • Authorizations to Use or Disclose Protected Health Information
    For routine release of health information

PDF

  • Authorizations for Electronic Communication
    For Release of Identifiable Information by Video/Tele-Conference or Audio-Conference – do not use for E-mail correspondence – see below.

PDF

  • Online form for Email and Other Media
    Use only this form to authorize Email correspondence. It can also be used for video- and audio-conferencing. You will be redirected to an outside website. Click here.
  • Authorization for the Use of De-Identified Health Information for Publication and Educational Purposes

PDF

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