Medical Records Release
In order for Grand Peaks to request medical records on your behalf, a Patient Authorization for Use and Disclosure of Protected Health Information Form (Medical Records Release) will need to be completed.
Please complete and sign the form
You may return this form to either one of our Grand Peaks locations, fax to the number on the form, or
email to one of our clinics listed below.
Medical & Pharmacy: firstname.lastname@example.org
Behavioral Health: email@example.com
If you have questions, please call us at (208) 356-4900.