Release of Information Form
Providing Information to Your Care Team
If you need to provide information to a member of your care team or would like us to share information with another provider, please complete our release of information form below.
Service Update: As of Mon 8/17, Primary Care appointments with Excelsior Family Medicine will be in-person at 3754 Indian Trail. All other services remain virtual or offsite until further notice.
If you need to provide information to a member of your care team or would like us to share information with another provider, please complete our release of information form below.