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Lubbock Campus Forms


Authorization for Release of Patient Information

General English Version Spanish Version
Psychiatry English Version Spanish Version
Family Medicine English Version Spanish Version
Grand Expectations OB/GYN English Version Spanish Version
International Pain Center English Version Spanish Version
Larry Combest Community Health and Wellness Center English Version Spanish Version
MPIP Business Office English Version Spanish Version
Ophthalmology English Version Spanish Version
Pediatric C.A.R.E. Center English Version Spanish Version
Southwest OB/GYN English Version Spanish Version
Speech, Language & Hearing Clinic English Version Spanish Version
Student Health Services English Version Spanish Version
Sunrise Canyon Clinic English Version Spanish Version


Authorization for Release of Psychotherapy Notes

General English Version Spanish Version
Family Medicine English Version Spanish Version
Psychiatry English Version Spanish Version
Southwest Institute for Addictive Diseases English Version Spanish Version


Notice of Privacy Practices - Lubbock Only

Notice of Privacy Practices Handout (Lubbock Only) English Version Spanish Version


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