Downloadable authorization form - Onslow Memorial Hospital 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin with Section A, where you will enter your personal information. Fill in your first, middle, and last name, along with your telephone number, social security number, and date of birth.
3. Specify to whom the medical information may be released by providing the name and contact details of the person or organization.
4. Choose your preferred method of disclosure: pick up, mail, fax, or electronic. If faxing, ensure you include the correct fax number.
5. Indicate which specific documents are needed by checking the appropriate boxes for items like lab reports or consult notes.
6. In Section B, read through the understanding statements carefully. Confirm your authorization by signing and dating at the bottom of the form.

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