The following forms provide authorization to release or obtain medical information.

If you are a patient requesting medical records, click here to download the form.

If you are a provider requesting medical records, click here to download the form.

You may get the form to us in one of three ways:

1) Fax completed form to 479.463.1239.

2) Mail completed form to:

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

3) Deliver the completed form in person to the address listed below:

Washington Regional Medical Records Department
3318 N. Northhills Blvd., Ste. 110
Fayetteville, AR 72703

For questions, call 479.463.1158.