Release of Information Form

You must fill in and sign a release of information form if you would like me to communicate with anyone regarding your or your child’s care.

This form is not available as an online form.  Please click the link below and print as many copies of the form as you need.  Please fill them out and sign them. They can then be returned to the office via fax, email, US mail, or in person at your appointment.

Thank you.

View/Print Release of Information Form

Pin It on Pinterest