Welcome to Senter Dermatology

Opening Hours : Mon - Fri 9:00am - 4:30pm
  Contact : 907-276-1315

Release For Medical Records

AUTHORIZATION TO RELEASE HEALTHCARE INFORMATION


The health care information on the above mentioned patient.

If this request and authorization applies to specific dates of service, please specify the date range below.

********** THIS AUTHORIZATION EXPIRES 1 YEAR AFTER IT IS SIGNED**********