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

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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.



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About Washington Regional

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

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Quality and Recognition

Report to the Community
Consumer Choice #1 2012-13
Best Regional Hospitals U.S. News 2011-12
Top Performer Joint Commission 2011
Organ Donation Medal of Honor 2012
Best Hospital CitiScapes Magazine 2012
Celebrate Magazine Very Best 2012

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Medical Release Form
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