Authorization to Use or Disclose Protected Health Information (PHI) - Sonora Quest 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the Patient Identification section. Enter your name, date of birth, address, phone number, and any additional address details as required.
3. In the Delivery Requirements section, select how you would like to receive your results: U.S. Mail, Secure Fax, Encrypted Email, or Unencrypted Email. If choosing email options, provide the appropriate email address.
4. Complete the Information to be mailed to section by entering the company or person’s name and their contact details including phone number and address.
5. If you want an additional copy sent elsewhere, fill out the Additional Copy section with the same details as above.
6. Read through the authorization statements carefully. Your signature is required at the bottom along with the date and requestor's information if applicable.
7. Once completed, save your form and choose to either mail it, scan and email it, fax it, or drop it off at a Patient Service Center.

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