Medical Record Release Form

ADMINSTRATION SERVICES

Your medical information is highly confidential and if you choose to have your information transferred to or from The Portland Clinic, we require that you complete a Release of Information form prior to having your information transferred.  (Copying fees may apply).

 

RELEASE FORMS

  • Transferring Information to The Portland Clinic: If you are transferring your medical record information from an outside physician's office to a physician at The Portland Clinic, we ask that you complete the Release of Information form, to have your records released from their office.  You will need to fax this form to the outside physician's office and they will send your information over to our office. [Download pdf]
  • Transferring Information from The Portland Clinic: If you are a current Portland Clinic patient and need to have your records transferred to a non-Portland Clinic medical office, you will need to complete the Release of Information form.  Please fax the completed form back to our Release of Information department at 503-968-0586. [Download pdf]

 

FOR QUESTIONS, PLEASE CONTACT OUR RELEASE OF INFORMATION DEPARTMENT

The Portland Clinic South Office

6640 SW Redwood Lane

Portland, OR 97224

Phone: 503-620-7358 X 2948

 

Fax:503-968-0586

 

If you are a new patient please download our New Patient Information form to get started. [Download pdf]