Jotform’s medical records release authorization template allows you to quickly and easily gather signatures from patients or parents or guardians in order to release sensitive medical records. I hereby authorize the following health care professional, medical facility, mental health facility, laboratory, paramedical facility, medical examiner, medical records service, prescription. Fax or mail the appropriate site listed on page 2 of the. The sample medical release form is available online that can be used to create one in word doc format. I hereby authorize the release of my medical information to the designated recipient.
