Authorization to Release Confidential Information

This Authorization to Release Confidential Information will ensure that only the information you specify is released on your behalf. This authorization can be given to a physician, attorney, hospital, clinic or school. The confidential information to be released can vary from financial, educational and legal to your social interactions, both online and in person. This Authorization is beneficial because it protects your privacy, contains an expiration date and can be revoked at any time. (continued ...)