Thank you for choosing Wildwood!

Medical Release Form

IMPORTANT: Please download, read, and fill out this “Information Release” form. This gives Wildwood Clinic permission to request medical records on your behalf once your application has been approved. In some cases we may need to assess your medical records prior to approval. Having your medical records well in time will help the medical provider be adequately prepared for your visit and therefore provide the best possible care. You must fill out a separate form for each medical provider or medical institute from which you have sought medical care during your last three visits or within the past six months. Please send the completed form back to us at clinic@wildwoodhealth.org or fax it to us at 706-820-1474. Thank you for your cooperation.