Authorization Form
Please, print, fill-out and email it to [email protected].
Favor imprimir y completar esta forma y enviarla por correo electrónico a [email protected].
Authorization to Release Health Information Form
Please, print, fill-out and email it to [email protected].
Favor imprimir y completar esta forma y enviarla por correo electrónico a [email protected].
Authorization to Release Health Information Form