"If you wish to authorize another medical professional to release information TO me regarding your medical or psychiatric care please download this form (Release of info TO me document). Print it, fill it out and sign it. You can fax it or mail it to the provider or hospital who should release the information."
"If you wish to authorize me to release psychiatric and medical information about you to another provider, you need to download this form (Release of info FROM me document). Print it, fill it out and fax or mail the signed form to me to the address printed on the top of the page."