HIPAA Authorizations and Release

There are two forms that need to be signed on this page.  Please click on the red "Add Use/Disclosure Authorization" button to open the first form.  Please read and sign if you agree.  Then click on the second red button Add Release Authorization.  If you choose to allow us to speak to someone about you or your medical records, they must be listed on this form.   Both forms will be added to your medical record via HIPAA Compliant transmission and will be email to you upon submission to Viking.

If you have any questions, please call the office at 210-826-8900.

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If your provider has asked you to fill this form out, please choose your provider from the list below and a copy of your form will be sent directly to the provider for use during your consult, otherwise do not make a choice in this box.