Sign a Records Release Online
Need records sent to another doctor, or want us to get your records from a previous office? You can sign the authorization electronically in a few minutes. No printing, scanning or faxing.
How it works
Send a message in the patient portal or call us. Tell us which office or hospital is involved and whether we are requesting your records or sending them.
We send an electronic authorization form from our medical record system (Elation) to the email we have on file. You do not need a portal account to open it.
Check the details, sign with your finger or mouse and submit. The signed form is saved to your chart, and we send or request the records for you.
What the form covers
- Which records are shared (for example: everything, or only labs and visit notes from certain dates)
- Who sends the records and who receives them
- Why they are being shared (for example: continuing your care, or at your own request)
- When the authorization expires
- Your right to revoke it in writing at any time
- Separate, specific permission for sensitive records: substance use treatment, mental health treatment and HIV test results
Having the name, phone and fax number of the other office ready makes it faster.
Do I always need to sign one?
Not always. Doctors may share records with each other for your treatment without a signed release, but many hospitals and offices ask for one anyway. Records of substance use treatment, mental health treatment and HIV testing usually need your specific written permission. We will tell you if a release is needed.
Can I change my mind?
Yes. You can revoke a release at any time by telling us in writing, for example with a patient portal message. Revoking it does not undo records that were already shared.
Prefer paper?
You can print, sign and return our standard authorization form instead.
Printable release form (PDF)Another office requesting records?
Fax a signed authorization to (855) 457-1293, or call (262) 242-0700. Electronically signed authorizations are accepted.
Questions?
Email is fine for asking us to send the form. Please don't include health details in email. Use the patient portal for those.