Medical Release Form at Priority Urgent Care and Walk-In Clinic

Get trusted and comprehensive care. For more information regarding testing and test results, visit Priority Urgent Care. Contact us today, or book an appointment online. We have convenient locations to serve you in Ellington CT, Unionville CT, East Haven CT, Cromwell CT, Oxford, CT and Newington, CT.

According to the Health Insurance Portability and Accountability Act (HIPAA) guidelines, Priority Urgent Care as your healthcare provider can send copies of your medical records to another of your healthcare providers or your health insurance plan as needed for treatment or payment. At registration, we ask you to sign an authorization to allow for those routine requests to readily facilitate the continuum of care and as needed for payment by your insurance company.

Should there be an occasion when you need copies of your medical record information for personal or other reasons, we request that you put your request in writing. An Authorization to Release/Obtain information form is available here for your use.

Please complete it and send it to our Ellington clinic office at 105 West Road, Suite 5, Ellington, CT 06029 or fax 860-926-4245.