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Washington Regional Medical Center Walker Heart Institute Northwest Arkansas Neuroscience Institute Senior Health Women and Children's Health Total Joint Center

Interact & Connect

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Medical Release Form

The following form provides authorization to release or obtain medical information. 

Please click here to download form.

Mail completed form to:

Medical Records Department
Washington Regional Medical Center
3215 N. Northhills Blvd.
Fayetteville, AR  72703

You may also deliver the completed form in person to the department from which you would like to request information.

Career Opportunities
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About Washington Regional

About Us
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 Washington Regional
 3215 N. North Hills Blvd.
 Fayetteville, AR 72703
 (479) 463-1000


Prevention and Wellness Programs
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Interact & Connect: Online Tools


Quality and Recognition

Report to the Community
VHA Clinical Excellence Award 2014
Top Performer Joint Commission 2013
Best Hospital CitiScapes Magazine 2014
Celebrate Magazine Very Best 2014
Organ Donation Medal of Honor 2012



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HIPAA Privacy Notice
Medical Release Form
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