Fax or mail the appropriate site listed on page 2 of the. Please fill out this form to authorize the release of your medical records. To request release of medical information please complete and sign this form i, ____________________________________hereby voluntarily authorize the disclosure of. I hereby authorize the following health care professional, medical facility, mental health facility, laboratory, paramedical facility, medical examiner, medical records service, prescription. Completed and signed forms can be submitted the following ways:
