Get Dr Connect

Filling out the Dr Connect authorization form is a crucial step for granting permission to release your medical information. This guide will provide you with clear instructions on how to effectively complete the form online.

Follow the steps to successfully complete the Dr Connect form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin filling out the patient information section, including your social security number, clinic number, date of birth, address, city, state, zip code, and telephone number. Ensure all details are accurate to avoid any delays.
3. In the authorization section, carefully read the statement regarding the release of your health information. Acknowledge that this may include sensitive information such as mental health records and substance abuse treatment.
4. Indicate the recipient of the health information by filling in the release to section, which includes the recipient's address, city, state, and zip code.
5. Provide the reason for the disclosure in the designated field. Be clear and concise to ensure your intentions are understood.
6. Review the information you consent to be disclosed, ensuring you understand that your complete medical record will be released. Acknowledge any specific records that are part of this disclosure.
7. Sign and date the form, ensuring that you provide your printed name as well. If you are signing on behalf of someone else, include your relationship to them.
8. Save your changes to the form. You can also choose to download or print the completed form for your records or future reference.
9. After reviewing all provided information, submit the form according to the guidelines specified by your healthcare provider.

Complete your documents online today to ensure your medical information is efficiently managed.