Forms & Paperwork

Permission to Share Health Information

At Marin Community Clinics (MCC), we respect your privacy and are committed to protecting your personal health information. If you would like to authorize MCC to share information about your care with trusted family members, friends, or caregivers, please complete the Permission to Share Information form. This helps our care teams communicate with the people you choose to involve in your health care.

Download the form: Permission to share information with Family, Friends, and Caregivers (English / Spanish)

Protecting Your Privacy, Earning Your Trust

At Marin Community Clinics, protecting your personal health information is an essential part of providing quality care. We follow HIPAA privacy and security standards to safeguard your information, respect your confidentiality, and ensure you feel safe and supported every step of the way.

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Authorization Forms

Authorization for Release of Health Information form
(English / Spanish)