PHI Release Form

Request or Authorize the Release of Your Health Information

To request access to your personal health records or to authorize the sharing of your information with another individual, provider, or organization, please complete and submit our Personal Health Information Release Form. This ensures we can securely and appropriately handle your request in accordance with HIPAA and applicable privacy laws.

Download and fill out the form below. Once completed, you can email it to centrum.medicalrecords@neuehealth.com or print the form and bring it to your next appointment.

For questions or help with the process, please contact our office directly.