Spring harbor hospital westbrook me 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the Patient Name and Patient Date of Birth in the designated fields at the top of the form.
3. In the 'Authorization to Release Information' section, clearly indicate whether you authorize the release of medical records by checking the appropriate boxes.
4. Fill in the details for where to send or obtain medical records, including Name, Street, City or Town, State/Zip.
5. Select which specific information you wish to release by circling the relevant options provided in the list.
6. Sign and date the form at the bottom. If applicable, include your relationship to the patient if you are a legally authorized representative.

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