This form is used to give Medical West Podiatry authority to release your medical record and its information to other requesting entities. This form also allows the office to request copies of your health/medical records from other entities—this is especially important for patients who transfer their care from other providers. You have the option to decline the release of your health information from this office—this will be noted in your medical chart.

This form explains the office privacy policy, which is HIPPA-compliant. All of your health and treatment information is protected and secured in our office.