Medical Records Release

Use this form to release my Jackson Siegelbaum Gastroenterology or West Shore Endoscopy Center medical records to another provider or healthcare team.

Please complete the form below to authorize Jackson Siegelbaum Gastroenterology and/or West Shore Endoscopy Center to release your medical records to your provider or healthcare team. If you have any questions, please reach out to our Medical Records Team at 717-761-0930 and we will be happy to assist you.

If you cannot view the form below, you may access our HIPAA compliant Authorization for Use and Disclosure of Medical Information form.