Medical Release Form Template

What is a medical release form?

A medical release form is a document that gives healthcare providers permission to share the patient’s medical information with other parties that can help diagnose and treat the patient’s condition.

What is on a medical release form?

The medical release form contains an agreement that explains what the patient or the patient’s legal guardian needs to consent to before starting the treatment. If the patient is a minor, the legal guardian or parent has to provide both personal details such as name, email, and phone, as well as the relationship with the child, and the name of the family’s physician. Allergies and medications must be filled in the document too since they can affect the way the patient reacts to certain treatments.  

How can I create a medical release form?

You can customize our medical release form template on 123 Form Builder without worrying about building one from scratch. You can update the consent agreement on the form, change the fields, add your logo, add an electronic signature, and more. And you don’t need programming skills, just a 123 Form Builder account. 

Is this Medical Release Form template HIPAA-compliant?

Yes, 123 Form Builder is HIPAA-compliant but only if you contact us for an Enterprise plan that includes HIPAA-compliant forms. Once we understand your needs, we’ll tailor our form builder according to your needs.