Authorization to Release Information

Downloadable patient forms you can print and fill out before your next visit to Center for Dermatology & Plastic Surgery

These forms are used to release your protected health information as required by federal and state privacy laws. Your authorization allows the Health Plan (your health insurance carrier or HMO) to release your protected health information to a person or organization that you choose. For your convenience, we have provided downloadable forms to save you time. Please print, and complete before visiting our office.

Downloadable Forms