Patient Forms

Print, download or complete forms online

We’re making waiting room paperwork a thing of the past. Prepare for a visit with your new WellSpan doctor, seek financial assistance, make plans for your care or access your private health record.

Follow the links below to our most-used health care forms and complete them when it’s convenient for you. Read, download and print what you need. You can even complete some forms online.

Authorization to Use or Disclose Health Information

This form can be used to request access to your medical record information or to share it with your doctor’s office. Requests can be made for your own record, or for someone for whom you are a legal representative.

21st Century Cures Act Request Form

Federal law supports seamless and secure access to electronic health information for you and your doctors. In accordance with the law, we offer this online form for requests to access, exchange or use health information.