Authorization Forms Library
To expedite the process, please make sure you:
1) PRINT the full name of the person seeking care
2) SIGN and DATE the form
3) FAX or MAIL the form to: 866-920-5565 or eHealth Technologies, 250 Thruway Park Drive, West Henrietta, NY 14586
Authorization Forms links:
- Columbia University Medical Center: Authorization to Release Medical Information
- Hinge Health: Authorization to Release Medical Information
- Mayo Clinic: Authorization to Release Protected Health Information
- Mindstrong Health: Gabe Aranovich, MD
- Mount Sinai Medical Center: Patient Authorization for Release of Medical Information
- New York City Health and Hospitals Corporation (NYCHHC): HIPAA Authorization to Disclose Health Information
- NewYork-Presbyterian Hospital: Authorization Form to Disclose Protected Health Information/Medical Records (English)
- NYU Langone Medical Center: Authorization for Release of Protected Health Information (PHI)
- Thomas Jefferson University: Consent to Release Medical Information
- UPMC: Patient Authorization