Medical Records Release Authorization

About this template

Need a medical records release form for your medical practice? 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 to another party. Send out invitations via email, and patients can fill out and sign your authorization form from any device. Once signed, a finalized PDF document will be automatically sent to your inbox — ready to download, print, and share for your records.

Customizing this Medical Records Release Authorization form couldn’t be easier. Using Jotform’s drag and drop builder, you can include your practice’s branding, add or change form fields and checklist items, change fonts and colors, and more. Get rid of messy paperwork and securely collect electronic signatures with Jotform Sign.

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These templates are suggested forms only. If you're using a form as a contract, or to gather personal (or personal health) info, or for some other purpose with legal implications, we recommend that you do your homework to ensure you are complying with applicable laws and that you consult an attorney before relying on any particular form.