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Authorization for Release
of Health Care Information
Please click on the form
below. Print the form from your printer, complete it by hand and
mail to our office! We do not send medical records electronically
(through the Internet).
Authorization for Valley Women's Clinic to Disclose or Release my
Health Care Information
(Adobe Acrobat Reader
required. To obtain a free version, click on link below
Get Adobe Acrobat Reader for Free!
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