Authorization for Release of Medical Information

To request that Hill Physicians Medical Group releases your Claims/Billing Information, please complete and submit the request form. For release of medical information pertaining to any and all of the following Health Information, please contact your provider’s office directly.

  • Medical Records
  • Drug/Alcohol Abuse Records
  • Mental Health Records (which may be retrieved from your provider)
  • HIV Test Results

Spacing: small
Spacing: large