Resources · Policies & forms
Medical Records Release Form
We appreciate your trust in Vanguard Gastroenterology and are committed to protecting your privacy and confidentiality. If you have any questions or need help with the form, please don't hesitate to contact us at (212) 889-5544.
How it works
Authorize the release of your health records in four steps.
Download the form
Open the Authorization for Release of Health Information PDF below — print or fill it digitally.
Complete every field
Patient details, records to be released, the receiving provider, and the time period covered must all be specified.
Sign and date
Your signature authorizes the release. For minors, a parent or legal guardian must sign.
Return it to the office
Drop it off at either location, mail it in, or call the office and we'll guide you on the fastest secure delivery.
Need help?
Our patient-care team can walk you through the form, confirm what records you need, and tell you exactly where to send them.