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Information used or disclosed pursuant to this authorization may be subject to redisclosure by the recipient and may no longer be protected by the Federal Privacy Rules. Willow Creek Women s Clinic 130 S. Barstow Eau Claire WI 54701 P 715-832-9292 F 715-832-4172 Authorization to Release Health and/or Behavioral Health Care Information Patient Info Release FROM Disclosed TO Name Previous Name s Birth Date Phone Number Address City State Zip Individual/Facility/Organization Attn/Dept Contact...
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Step 1: Gather all necessary documents and information, including your personal identification, medical records, and any relevant insurance information.
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Step 2: Visit the Willow Creek Women's Clinic website or call their office to schedule an appointment.
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Willow Creek Women's Clinic is a medical facility that specializes in providing healthcare services specifically for women.
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