Release of Information Form - Oct 2020

The form is used to authorize the release of confidential information to a third party. It must be completed by the individual whose data is being released. The document requires the individual's personal information, the information being released, and the name and contact information of the third party receiving the information.

Individuals who want to authorize the release of their confidential information to a third party.

The completed Release of Information form should be submitted to the organization or individual who will receive the released information.