If you would like to grant permission to another individual(s) to discuss your healthcare and make requests on your behalf, please fill out this form and fax it to the office at 706-684-0753. This form must be updated every 90 days and must be on file before we release your information to another individual. This includes parents (excluding minors), siblings, spouses, friends, and caretakers.
This page contains all of our downloadable forms and documents.
Before we can release your medical records to another facility, we must have a signed Authorization on file. Please fax to 706-684-0753 with a copy of your driver's license or identification card. You may also bring it by in person.