Please find a release of Information Form available online. If you are looking for a form that is not listed below, please call Southwest Health at (608) 348-2331 for further assistance.

• Click here to print an Authorization to Disclose Protected Health Information Form
• There are multiple ways to submit your completed form. You can either:
  • Submit your form by faxing it to 608.342.5011
  • Mail your form to Southwest Health at 1400 Eastside Road, Platteville, WI 53818
  • Drop off your form at Southwest Health’s Front Desk of the ER, 1st or 2nd Entrance.

Do you have any additional questions? Contact Health Information Management at (608) 342 – 4718, option 2.