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AUTHORIZATION FOR THE RELEASE OF MEDICAL ... - …
www.everettclinic.comINSTRUCTIONS & IMPORTANT INFORMATION Please read all information and instructions before completing and signing the authorization form. THERE MAY BE A CHARGE FOR COPIES OF YOUR MEDICAL RECORD UNLESS YOUR COPIES ARE BEING SENT TO ANOTHER PHYSICIAN OR HEALTHCARE FACILITY. Many patients ask The Everett Clinic …
AUTHORIZATION FOR THE RELEASE OF MEDICAL …
www.everettclinic.com10-009 7/13 INSTRUCTIONS & IMPORTANT INFORMATION Please read all information and instructions before completing and signing the authorization form.