Release of Information Form

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Release of Information Form

To ensure that your medical information remains private and under your control, we require that you complete a Release of information Form to provide medical records.

Record release to a physician office is provided at no charge. Call our office at (541) 684-9451 to receive a price for record release if not a physician office.

Download the Release of Information From Pain Consultants Form

 
Download the Release of Information To Pain Consultants Form

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