For your convenience, you can complete the fillable forms below by typing your answers, saving to your computer, then printing to bring with you to your first visit. Or if you prefer, download the forms, print, write your answers, and bringing them with you to your first visit.
In order for WVCI to release a patient’s confidential medical records to a third party, the authorization form below must be completed and signed by the patient. The authorization form can be mailed, hand-delivered, or faxed to the attention of the Medical Records Department.