Get Medical Release Authorization Form - Fashion Institute Of Technology

This guide provides clear instructions on how to complete the Medical Release Authorization Form for the Fashion Institute Of Technology online. Following these steps will ensure a smooth and efficient process in authorizing the release of medical records.

Follow the steps to complete the form effectively.

1. Press the ‘Get Form’ button to access and open the Medical Release Authorization Form in your preferred online document editor.
2. Begin by entering the current date in the designated field.
3. In the space provided, print your full name to indicate that you are requesting the release of your medical records.
4. Fill in the name of the practitioner and their title who will receive your medical records.
5. Complete the address section for the practitioner, including the city, state, and zip code.
6. Enter the phone number of the practitioner.
7. Provide your signature in the indicated area to authorize the release.
8. If applicable, enter the fax number where the records can be sent.
9. Input your social security number.
10. Specify your date of graduation from the Fashion Institute Of Technology.
11. Fill in your birthdate.
12. If applicable, provide the date of withdrawal from the Fashion Institute Of Technology.
13. Select one of the provided options to indicate the specific medical records being requested.
14. Be aware that if you are not completing this form in person at the F.I.T. Health Service, it must be notarized. Unnotarized forms will not be processed.
15. Review the completed form for accuracy and clarity.
16. Once finalized, you can save changes, download, print, or share the completed form as needed.

Complete your Medical Release Authorization Form online today!