Obgyn release 2025

1. Click ‘Get Form’ to open the Medical Records Request/Release in the editor.
2. Begin by entering your Patient Name and Date of Birth at the top of the form. If applicable, include any Previous Names for accurate record retrieval.
3. Provide your Phone Number for contact purposes. Next, specify where you are requesting records from and where they will be released to by checking the appropriate boxes.
4. Fill in the details for OBGYN West, including their address and contact information. Be specific about which medical records you wish to release by checking the relevant boxes such as Office Notes or Lab Reports.
5. Indicate the reason for the release by selecting one of the options provided. Remember that a fee may apply depending on your choice.
6. Sign and date the authorization section at the bottom of the form. This authorization will expire one year from your signature date.

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