Release of Information Form Template
Collect signed authorizations, requester details, and disclosure purpose in one place, so your team processes information requests without chasing paperwork.
Most teams manage release of information requests through email threads — forwarding unsigned forms, following up on missing fields, and manually tracking which requests have been processed. That creates delays and compliance risk when records need to move quickly. Typeform's release of information form template gives healthcare administrators, legal teams, and HR departments a consistent way to collect complete, signed authorizations before releasing any records.
The form captures requester name and contact details, relationship to the subject, type of information to release, purpose of disclosure, date range of records, and consent. The one-question-at-a-time format keeps requesters moving forward without losing their place. Conditional logic branches questions based on a requester's answers. A requester authorizing release to a legal representative sees different fields than one authorizing release to a healthcare provider—keeping the form specific to each disclosure scenario.
Customize the fields to match your organization's authorization requirements or compliance obligations. Share the form via email, embed it on your client or patient portal, or send it as a direct link. Pipe responses straight into Google Sheets, Airtable, or your records management system via Zapier. Replace the inbox thread with a single, trackable process—so no authorization request falls through the cracks.
A release of information form authorizes an organization to share a person's records with a specified third party. It captures who is requesting the information, what records they need, the purpose of the disclosure, the date range of records, and the subject's consent. Every field documents that the disclosure of information was authorized.
Anyone requesting access to records held by another organization needs to complete one—a patient requesting their medical history, a former employee requesting payroll records, or a student requesting transcripts. The form protects both parties: the requester knows exactly what’s needed, and the organization releasing records gets documented authorization. Healthcare administrators, HR teams, legal departments, and school registrars all process these requests regularly.
A complete release of information form covers:
- Full name of the person whose records are being released
- Requester name, contact details, and relationship to the subject
- Type of records requested (e.g., medical, financial, educational, employment)
- Purpose of the disclosure
- Date range of records to release
- Recipient name and contact details
- Expiration date of the authorization
- Signature and date of consent
Digital forms with electronic signatures are legally valid in most jurisdictions under laws like the US ESIGN Act and the EU's eIDAS regulation, but requirements vary by record type and location. Medical records in the US follow HIPAA requirements, while education records fall under FERPA, and each sets specific rules for what a valid authorization must include. Before using this form for regulated records, verify the setup meets your specific legal and compliance requirements with your legal team.
Connect your form to Google Sheets or Airtable via Zapier and every submission populates a live tracker—requester name, record type, date submitted, and authorization expiration date, all in one place. Filter by status to flag requests that need follow-up or consents approaching their expiration date. That gives your team a clear view of every open request, without digging through an inbox to find out where things stand.
Get inspired by relevant templates and categories
3200+ Templates, 300+ Integrations
With Typeform, you can customize everything
Change text, colors, and even logos to match the look and feel of your brand. Then embed forms smoothly onto web and email.
Make forms feel effortless to fill out. Pace questions, call people by their name, and adapt the flow based on the data they share.
Stay efficient by connecting forms to your workflow. Typeform integrates with 300+ tools including Slack, Zapier, and HubSpot.
