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College Station, TX

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979-693-6000 (phone)

979-693-1900 (fax)

877-377-4ENT (toll free)

 
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Release of Information Authorization Form PDF Print E-mail

Download Release of Information Authorization Form (.pdf format)

Charges for duplicating and handling may apply.

After completing this form either:

Fax it to: 979-693-1900

or

Mail it to:

Texas ENT and Allergy
P O Box 10194
College Station, Texas 77842
ATTN: Medical Records


 
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