Consent Form

You can authorize the Kearney Clinic, PC to release your medical records to the facility or provider of your choosing. You must first have a Kearney Clinic Patient Portal account. Follow the instructions below on how to authorize the release of your medical records.

If you have a Kearney Clinic Patient Portal account:

1. If you have a Kearney Clinic Patient Portal account, log into the account
2. Go to Patient Forms
3. Click on the Authorization for Release of Medical Information link
4. Complete the form and SAVE

If you do not have a Kearney Clinic Patient Portal account:

1. Go to the Patient Portal quick link
2. On the Kearney Clinic Patient Portal, click on CREATE ACCOUNT
3. Complete the registration to create the Kearney Clinic Patient Portal account
4. Log into the account
5. Go to Patient Forms
6. Click on and complete the Patient Information Form, don’t forget to SAVE
7. Click on and complete the Authorization for Release of Medical Information form and SAVE

Patient Portal