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Services
Gainesville Clinic
Primary Care
DOT Physicals
In-Office Procedures
IV Hydration Lounge
Oak Concierge
Post-Acute Facilities
Primary Care
Acute Care
Critical Care
Mental Health
Nephrology
Podiatry
Urology
Wound Care
Patients
Scheduling
Medical Release Form
Facilities
Careers
Blog
About
Contact
Medical Release Form
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I understand that once my records are released, they may be re-disclosed by the recipient and may no longer be
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Treatment, payment, or eligibility for benefits will not be conditioned on signing this authorization.
This authorization will expire one (1) year from the date signed below unless otherwise specified.
I understand that I may revoke this authorization at any time by submitting a written request to Synergy Medical Group, Except to the extent that action has already been taken in reliance on it.
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