AUTHORIZATION TO RELEASE INFORMATION - PatientPop 2025

1. Click ‘Get Form’ to open the AUTHORIZATION TO RELEASE INFORMATION - PatientPop in the editor.
2. Begin by filling out the PATIENT INFORMATION section. Enter your last name, first name, middle initial, address, occupation, sex, marital status, age, city/state, zip code, date of birth, and contact numbers.
3. In the EMERGENCY CONTACT section, provide the name of your emergency contact along with their relationship to you and their phone number.
4. Review the AUTHORIZATION TO RELEASE INFORMATION section carefully. Sign and date where indicated to authorize iSight Vision Care to release your medical information.
5. Complete the PATIENT HEALTH HISTORY QUESTIONNAIRE by answering questions regarding your eye history and any medications you are currently taking.
6. Finally, review all sections for accuracy before saving or submitting your completed form through our platform.

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