Forms
PATIENT INFORMATION
Health Information
- 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.
- Print an Authorization to Disclose Protected Health Information Form in English or Spanish
- 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.
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