AUTHORIZATION TO RELEASE PROTECTED - NUWAY 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your full legal name, date of birth, and social security number in the designated fields.
3. Provide any prior aliases, phone number, client number, and your complete address including city, state, and zip code.
4. Select the appropriate NUWAY location and check the box for authorization type: Obtain, Release, or Exchange.
5. Fill in the information of the person or organization you wish to send records to, including their name, relation to you, and contact details.
6. Indicate the purpose of release by checking all applicable options such as Treatment/Continued Care or Evaluation/Assessment.
7. Specify what information you want released by checking relevant boxes like Assessments/Summaries or Medical History.
8. Choose whether to release information for specific dates or all dates of service.
9. Initial where required and ensure you sign and date the form at the bottom before submitting.

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