Medical Release Form - Mondays at Racine 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the Patient Information section. Enter the patient's name, address, phone number, and date of birth accurately.
3. In the Hospital Affiliation section, specify the hospital associated with the patient seeking medical clearance for salon services.
4. Review the list of services provided by Mondays at Racine. Ensure you understand which services are available and any potential concerns regarding participation.
5. Complete the Physician's section by selecting one of the recommendations regarding patient participation. Ensure that all fields, including physician’s name, hospital affiliation, signature, and contact information, are filled out legibly.
6. Once all sections are completed, review your entries for accuracy before saving or sending the form.

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