We have the forms you need to run your business. Save money on your pre-printed forms and products. This popular item: DIS100 Two Part Patient Disclosure Authorization HIPAA Form 8 1/2 x 11″ is available as low as $37.41 for 50!
UPS ground shipping only $5 within the contiguous US (shipping additional to AK, Islands, US Territories and Canada).
Protect your practice and avoid privacy disputes with this clear, step-by-step form authorizing release of patient information. Includes your imprinted practice name, address, and phone number, up to 5 lines. 2-part form provides a patient copy and a 2-hole punched permanent record.
Meets HIPAA Regulations.
You can order online here 5Forms – DIS100 Two Part Patient Disclosure Authorization HIPAA Form 8 1/2 x 11″ or you can call Customer Service 1-855-5FORMS5 (
855-536-7675). Our customer service team is available via chat or phone Mon-Friday 9am-5pm EST.
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