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HIPAA Consent Form

The attached file contains the HIPAA consent form for the Lorain City Health Department.If you wish to obtain medical records of any kind, we must first have on file this signed form. Please print it out and mail, fax or bring it in to our office.

Fax to: 440-204-2526
Mail to: Lorain City Health Department
1144 West Erie Avenue
Lorain, OH 44052

Attached Documents:


HIPAA Consent Form.pdf





Lorain City Health Dept.
1144 West Erie Avenue
Lorain, Ohio 44052
Ph: (440) 204-2300
Fax: (440) 204-2526
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