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PERMISSION TO RELEASE RECORDS FOR TREATMENT PURPOSES New Bern Family Eye Care 2805 Village Way New Bern, NC 28562 (252) 6330016 Fax: (252) 6363895 Calico Family Eye Care P.O. Box 219 Alliance, NC

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What is records release form?

It is a document that authorizes the release of an individual's records to a specific party.

Who is required to file records release form?

Any individual who wants their records to be released to a specific party.

How to fill out records release form?

You can fill out the form by providing your personal information, the recipient's information, and specifying which records you want to be released.

What is the purpose of records release form?

The purpose is to allow an individual to authorize the release of their records to a specific party for a specific purpose.

What information must be reported on records release form?

Personal information, recipient's information, and details of the records to be released.

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