Release of Records Forms

Whether you are starting gynecological, prenatal, or other care at The Midwife Center, we ask that you fill out a release of records form prior to your scheduled appointment. You can also authorize The Midwife Center to release your records to another provider.

Please see below for the forms.

If you are transferring to The Midwife Center from another provider, please download and fill out this form releasing your records from that provider to us:

Authorization for Release of Protected Health Information to The Midwife Center Form

If you would like to request that The Midwife Center release your records to another provider, please download and fill out this form authorizing TMC to release your records from us to another provider:

Authorization for Use or Disclosure of Protected Health Information Form

Release of Records Forms

Release of Records - Them to Us

Release of Records - Us to Them