Medical Release Form

A medical release form template is the ideal tool to quickly and securely obtain patient consent for sharing health information with authorized individuals or organizations. A well-designed form template helps you:
  • Save time with an easy-to-fill structure
  • Reduce errors with clear fields
  • Maintain organized records
Use template
Preview
Created by forms.app Team
Copied 1 times
Preview

About this medical release form template

A medical release form is a document that authorizes healthcare providers to share a patient’s medical records, test results, and other health information with designated individuals or organizations. This form template comes with:

  • Patient information fields
  • Recipient organization detail fields
  • Date field
  • Signature field
  • Terms & conditions field

What can I ask in a medical release form?

This online medical release form example already comes with some definite fields and questions that collect vital data. However, if you still want to add more questions, here are them:

  • Which medical records would you like to release? (e.g., lab results, imaging, treatment history)
  • What is the date range of the records to be released?
  • Who will receive your medical records? (Name or organization)
  • What is the purpose of this release? (e.g., insurance, legal, personal use, transfer to another provider)
  • Do you understand that you may revoke this authorization at any time?

How can I analyze my medical release form responses?

As you share the medical release form, the responses will be listed in the “Results” tab. You can find them in detail under the “Responses” tab. On the “Statistics” tab, you can see the general picture. 

However, if you have lots of data, you can use forms.app AI insights. It is a smart feature that lets you analyze and gives you general trends, related charts, key points, and suggestions, as well as ask more questions about the analysis.  

Frequently asked questions (FAQs)

Is this medical release form sample free?

Yes, all the templates on forms.app are free to use. If the template suits your needs, simply click the “Use template” button. Customize it and share with your target audience. 

Can I add my logo to this template?

Yes, you can add your brand/company/organization’s logo and cover to make the form more personalized and look professional. 

Can I use this template in multiple languages?

Yes, you can use this form in multiple languages. forms.app lets Pro and Premium users add multiple languages and lets people choose their preferred language when they open up your form.

Use this medical release form template​

Utilizing this ready-to-use template is super-easy. Just follow the steps given below and share your form right away:

1. Import into your account

1. Import into your account

Check this medical release form example and click on "Use template" after making sure it meets your needs.

2. Customize however you like

2. Customize however you like

Change the design of your medical records release form. If you need, you can change the questions & fields.

3. Share it on all channels

3. Share it on all channels

Adjust access permissions, change the URL, generate a QR code, or obtain the embed code for your release form.

If you find this sample medical release form​ useful, it might be beneficial for you to check out the examples of medical release forms​ given below.

Need a custom medical release form?

Simply describe what you want to create in a few words and forms.app AI will craft the perfect medical release form for your needs.

Create with AI

Smooth process for everyone

The release of information is a smooth process thanks to forms.app’s free advanced features. Take a look at them:

  • File upload

    Easily gather medical documents and images from patients by dragging and dropping file or image upload fields into your medical release form template.

  • Contact fields

    Collect vital medical data from form takers, such as name, email, address, phone number, and more.

  • Legal fields

    Get people to agree to your terms and conditions before submitting their medical release data, or add a signature field.

  • Date & time fields

    Allow people to select a specific date or time. Ideal for recording consent dates and or tracking when medical information can be released.

  • Step view & list view

    List all your questions on pages, or simply show them one by one. Choose the view type that works best for you.

  • Open-ended fields

    Give people free space to write their medical details by choosing from short text, long text, masked text, and other open-ended fields.

See all features