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
