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Release of Information Template

A Release of Information Template lets you give written permission for someone to share your private records with a third party. Use this free, ready-to-edit form to authorize the release of medical, employment, or personal information safely and legally. Simply fill in the blanks, download, and get it signed in minutes.

What Is a Release of Information Form and Why Do You Need One?

A Release of Information form is a legal document that gives someone written permission to share your private records with another person or organization. It's most commonly used in healthcare, where a patient authorizes a doctor or hospital to send medical records to another provider, insurance company, or attorney. It's also used in employment, education, and legal settings whenever personal or confidential information needs to move from one party to another with the individual's clear consent. Without this signed authorization, most organizations are legally required to keep your information private and cannot share it, even if you asked them to over the phone.

Why Use a Ready-Made Template Instead of Writing One Yourself

Creating a release form from scratch can be risky, since it needs to clearly state what information is being shared, who it's going to, and how long the permission lasts to stay compliant with privacy laws. A ready-made Release of Information Template already includes the necessary sections — patient or individual details, description of information to be released, recipient details, purpose, and an expiration date — so you only need to fill in the specifics. This saves time, reduces legal risk, and ensures the form holds up as valid, signed consent.

Who Should Use This Release of Information Template

This template is useful for patients authorizing hospitals or clinics to share medical records, employees allowing former employers to release work history to a new company, students permitting schools to send transcripts elsewhere, and individuals working with lawyers or insurance companies who need access to personal records. Healthcare providers, HR departments, and schools also use this template themselves to collect proper consent before releasing anyone's information, keeping them compliant with privacy regulations.

How to Fill Out and Use This Release of Information Template Correctly

Start by adding the full name, date of birth, and contact details of the person whose information is being released. Next, clearly describe what specific information is being authorized for release, such as medical records, employment history, or academic transcripts. Add the name and contact details of the person or organization receiving the information, along with the reason for the release. Include a start date and an expiration date, since most releases are only valid for a limited time or a single use. Finally, the individual should sign and date the form, and a copy should be kept on file by both the releasing party and the requester.


How to Use Agreed Templates

Start With the Template

Open the Product Agreement Template in your Agreed workspace and begin with a ready-to-use agreement structure.

Customize Agreement Details

Add or edit product details, responsibilities, pricing, deliverables, timelines, and other terms to match your agreement needs.

Review, Sign & Manage

Send the agreement for review and approval, collect signatures, and manage the completed agreement securely in Agreed.

Frequently Asked Questions.

Everything you need to know about Agreed. Can't find what you're looking for?

Most release forms are valid for a specific time period, often 30 to 90 days, or until the stated purpose is completed, after which a new form must be signed for further releases.

Yes, in most cases you can revoke your authorization in writing at any time, although any information already shared before the cancellation cannot be undone.

Yes, healthcare providers are legally required to obtain a signed release before sharing medical records with anyone outside your direct care team, including insurance companies or other doctors.

A legal guardian, parent of a minor, or someone with power of attorney can typically sign on another person's behalf, as long as proper legal documentation is provided.

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