Medical Release Form

A medical release form is used to request that a healthcare provider release a patient’s medical records. Whether you’re a physician, dentist, or psychiatrist, Jotform’s free Medical Release Form template is a safe and secure way to collect sensitive medical information and electronic signatures from your patients. Rather than deal with messy paperwork, simply share your release form via email directly from your online dashboard. Patients can then fill out and sign your form from any device. Once submitted, you’ll receive a notification and finalized version of the document.

Make this Medical Release Form your own with Jotform’s intuitive drag-and-drop form builder. Upload your practice’s logo, choose fonts and colors, include additional text boxes and signature fields, edit the agreement text, and more. Once your Medical Release Form has been filled out, you can instantly download it for your records as a PDF document. Create a safe and streamlined signature experience for your patients with Jotform Sign.