354 Newnan Crossing Bypass, Suite 205, Newnan, GA 30265 Mon–Fri · 7:00am–5:00pm
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Patient Forms

Authorization for Release and Disclosure of PHI

Use this form to authorize Newnan Dermatology to release copies of your medical records — to you, to another provider, or to another facility. See medical records for delivery options and fees.

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Download the PDF

Prefer to handle it another way? Complete this form through the Patient Portal, or call (770) 520-8561 and our front desk will have a copy ready at your visit.

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