Free HIPAA Authorization Form
Ensure the Right People Have Access to Your Healthcare Information—When It Matters Most
Start Your HIPAA FormFirst document available free of charge
Why Choose Duckpins?
Built for real life. Designed for peace of mind.
Legally Compliant
All documents meet HIPAA regulations and Washington State law—including digital notarization.
All documents meet HIPAA regulations and Washington State law—including digital notarization.
Fast & Easy to Complete
Guided, jargon-free questions take you step-by-step through the process.
Guided, jargon-free questions take you step-by-step through the process.
Flat Rate Pricing
No hidden fees or subscriptions. Just $25 for your HIPAA Authorization Form - and you can get your first document for free.
No hidden fees or subscriptions. Just $25 for your HIPAA Authorization Form - and you can get your first document for free.
Secure & Shareable
Store your HIPAA form securely online, and share it instantly with family or healthcare professionals.
Store your HIPAA form securely online, and share it instantly with family or healthcare professionals.
Don’t Waste Time in Line or at the Lawyer’s Office
Get Started For FreeWhat Is a HIPAA Authorization Form?
A HIPAA Authorization Form is a legal document that allows a healthcare provider to share your medical records with a designated person or entity.
Without this authorization, even your closest family members may not be able to access your medical information.
A HIPAA Form:
Identifies the patient (you)
Specifies what medical information can be shared
Names who can receive your records
Outlines how long the authorization is valid
Gives you the right to revoke permission at any time
Make Your HIPAA Form in Minutes
Start Your HIPAA Form Now
Why You Need a HIPAA Authorization Form
Ensure Your Loved Ones Can Stay Informed
Without a HIPAA Form, doctors cannot legally share your medical details—even with your spouse, adult children, or parents.
Without a HIPAA Form, doctors cannot legally share your medical details—even with your spouse, adult children, or parents.
Prepare for Medical Emergencies
In case of an unexpected illness or accident, your trusted person will have the legal authority to communicate with doctors and access medical records.
In case of an unexpected illness or accident, your trusted person will have the legal authority to communicate with doctors and access medical records.
Make Care Coordination Easier
Need to gather and share information between providers? Ensure the right people can access and share your medical history by executing a HIPAA Form.
Need to gather and share information between providers? Ensure the right people can access and share your medical history by executing a HIPAA Form.
It only takes a few minutes to protect your healthcare information—but it makes all the difference when it’s needed.
Start Your HIPAA Form NowEASY • AFFORDABLE • LEGALLY BINDING
Create Your HIPAA Form—Without the Lawyer Price Tag
$25
First Document Available Free of Charge
Price includes:
Your HIPAA: Customize the document to match your preferences.
Online Execution: Make it legally binding without leaving your home —in record time. (additional $35 fee)
60-Day Vault Access: Try out your personal, secure document vault for free for 60 days.
Share Access with Loved Ones: Give decision-makers instant access when it matters most.
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What’s Included in a HIPAA Authorization Form?
A HIPAA-compliant authorization form must contain the following details:
Recipient of Information
Specify who can access your medical records
This could be a family member, legal representative, or another doctor
Scope of Information
Choose what medical details can be shared, such as:
Medical history
Test results & diagnoses
Mental health records
Expiration Date or Event
Decide how long the authorization remains valid
Some people choose no expiration to ensure access when needed
Right to Revoke
You have the legal right to cancel your authorization at any time
The form must explain how to revoke access
Patient’s Signature & Date
The document must be signed and dated to be legally valid - and it should be notarized
Duckpins makes it easy to create, store, and share your HIPAA Authorization Form—so your medical information is always accessible when needed.
Explore NowState Requirements for Medical Release Forms
In addition to federal HIPAA regulations, each state may have its own privacy laws governing medical record access.
State-Specific Regulations May Cover:
Additional protections for mental health, substance abuse, or reproductive health records
Specific rules for parental consent & minor patient rights
Extra authorization steps for HIV/AIDS-related medical history
All Duckpins HIPAA forms are fully compliant with Washington State laws.
Start Your HIPAA Form Now
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