These are forms that may be valuable to patients. Please refer to instructions on completing and returning the forms posted here.

Authorization for Disclosure of Medical Record Information - Please call the Medical Records Department if you have questions about this form at 740-446-5356 or 740-446-5358. Completed forms can be mailed back at the included address - Holzer Clinic, 90 Jackson Pike, Gallipolis, OH, 45631.

Holzer Clinic… Medical Excellence, Local Caring.

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