Below are authorizations that you might find helpful in situations where you need to request records, authorize your child to be seen, or authorize an individual to speak with us on your behalf. The forms are HIPAA compliant and will remain in effect until the date of your choice.
If you have questions about any of the authorizations, please reach out to our office (see Contact Us) and we will do our best to help out.
Authorization to Release Medical Information - Individual
This form is used to give an individual the authorization to call and speak with us on your behalf. This can include scheduling appointments, medication questions, billing, etc.
Authorization to Release Medical Information - Office/Facility
This form is used as authorization to request records from or send records to another office or facility
Authorization to Treat Patient without Parent or Guardian
