RELEASE OF INFORMATION FORM

FOR YOUR CONVENIENCE, HERE IS A RELEASE OF INFORMATION FORM. PLEASE FILL OUT AND EITHER:

​

EMAIL TO: 

​

FAX:

POPLAR (406) 768-6160

WOLF POINT (406) 653-6589

​

OR MAIL TO:

​

ATTENTION: MEDICAL RECORDS

P.O. BOX 38

POPLAR, MT  59255

​

OR

​

ATTENTION: MEDICAL RECORDS

315 KNAPP ST.

WOLF POINT, MT  59201