Free HIPAA Release Form
Federal privacy law keeps your health information locked down — even from the people you trust most. A HIPAA Authorization lets your doctors share records with a family member, caregiver, attorney, or anyone else you choose. Without one, even parents of adult children with disabilities can be shut out of medical conversations.
Answer a few plain-English questions and your completed authorization — compliant with 45 CFR §164.508 and valid in all 50 states — is emailed to you instantly, ready to print and sign. Completely free, from our nonprofit to your family.
100% FREE
Valid in All 50 States
Built on the federal HIPAA standard, with the specific consents states require for sensitive records.
You Stay in Control
Choose exactly who can receive records, what they can see, and when the authorization expires.
Sensitive Records Protected
Mental health, substance use, HIV, genetic, and reproductive records are released only if you specifically say so.
Done in 5 Minutes
Emailed to you instantly. Print, sign, and hand a copy to your providers.
What Your HIPAA Release Covers
- Who may disclose your health information
- Who may receive it — family, caregivers, attorneys
- Exactly what records are included
- Separate consent for sensitive categories
- Purpose of the release
- Expiration date or event you choose
- Your right to revoke at any time
- All acknowledgments required by federal law