Medical Authorization

AUTHORIZATION FOR THE RELEASE OF ALL MEDICAL INFORMATION

TO: Dr. Carl Chiropractor

PATIENT: Peter Plaintiff

DATE OF BIRTH: November 17,1953

SOCIAL SECURITY NO.: 000 00 0000

I hereby authorize and instruct you to release all medical records, all medical reports, all medical bills, and all medical information of every kind, to Alvin Attorney, 580 South High Street, Anytown, USA, 00000.

Among other things, this document authorizes you and instructs you to release the following information to...