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The Corvallis Clinic

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MENUMENU
  • Patient Portal
  • Primary Care
    • Family Medicine
    • Internal Medicine
    • Pediatrics
  • Specialty Care
    • Allergy & Immunology
    • Behavioral Health (Integrated)
    • Behavioral Health (Specialty)
    • Care Coordination
    • Concussion Care
    • Dermatology
    • Diabetes Education
    • Ear, Nose & Throat
    • Endocrinology
    • Foot & Ankle
    • Gastroenterology & Hepatology
    • Medicare Annual Wellness Visit
    • Neurology
    • Neuromusculoskeletal Medicine
    • Neuropsychology
    • Obstetrics & Gynecology
    • Occupational Medicine
    • Ophthalmology & Optometry
    • Orthopedic Surgery
    • Orthopedics & Sports Medicine
    • Physical Therapy
    • Rheumatology
    • Sleep Medicine
    • Surgery Center
    • Urology
  • Immediate Care
Home > Medical Record Release

Medical Record Release


Please download the appropriate authorization for your request:

The Authorization for Verbal Release of Medical Information form is used to:

  • Authorize a family member or trusted person to speak with your care team regarding your protected health information

This Authorization for Release of Medical Records and Medical Information form is used to:

  • Obtain a copy of your medical records
  • Authorize medical records to be released to a family member or trusted person
  • Authorize medical records to be released to another provider or facility

Please utilize the Revocation of Authorization Request form to:

  • Request that The Corvallis Clinic, P.C. revoke (cancel) an authorization previously provided

Mail or fax the completed form to:
DBS Health Information
Attn: Release of Information Staff
3680 NW Samaritan Dr.
Corvallis, OR 97330
Phone: 541-768-2368
Fax: 541-753-1966

If you have any additional requests regarding your medical records at The Corvallis Clinic, please email medical.records@corvallis-clinic.com.

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The Corvallis Clinic is dedicated to quality patient care and exceptional service. The Clinic is the largest multi-specialty medical group in the mid-Willamette Valley.

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