Record Release Forms

If you would like to transfer your health data to or from our office please fill out the forms below.

Please click on the form(s) below to download. Forms may be completed digitally and submitted via the link below or printed and brought with you to your appointment.

To digitally send your forms:

  1. Download the form and save to your computer
  2. Open in either Microsoft Word or Adobe Reader
  3. Fill in forms with your information
  4. Save
  5. Upload the completed forms via the link at the bottom of this page

Authorization of Confidential Health Info to ENT of IL
Authorization of Confidential Health Info from ENT of IL

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Click here to install Adobe Reader


Upload Your Completed Forms Here