A Release of Information Authorization Form is used by an individual to consent to the release of his or her medical records or x-rays to a new or different physician or health care provider. This release is also often used to assist in a job application or when applying for certain insurance. A parent or legal guardian may provide this authorization to consent to the release of records. A person who has power of attorney may also use this form. To protect a patient's privacy, the law permits disclosure of information only if the patient or his legal representative consents in writing or if the law otherwise permits it. We can send your medical records by email, by fax, by mail or you can pick them up at our Tempe office.
To Obtain an Authorization for Release of Information
- By Phone: (480) 962-0071
- By Fax: (480) 962-0590 (Attention: Medical Records)
- By Mail:
1255 W. Rio Salado Parkway, Suite 107
Tempe, AZ 85281
After downloading and filling out the form, please mail or fax us your request. Sonoran Spine makes every effort to fill medical records/x-ray requests in a timely manner. If the requested records or films are stored off-site, some records requests can take up to ten business days to process. X-rays/films are to be returned after their use per this request.
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