What does the Authorization to Release Information allow?

It authorizes Rockwall County Indigent Health Care to speak with listed family members or friends about questions or issues related to the participant’s client status.

What information does the form request?

It requests each listed contact’s name, phone number, and relationship to the participant, along with the participant’s signature and date.

Do I need a notary for the Authorization to Release Information?

No. The document is signed and dated without a notary, and it does not identify a notarized or sworn attachment or related step.

Rockwall County, TX · Rockwall County

No notary required

Authorization to Release Information

This form lets a Rockwall County Indigent Health Care program participant authorize discussion of their client status with listed family members or friends.

At a glance

Issued by: City of Rockwall County · Rockwall County, Rockwall County, Texas
Notarization: Not required: file this form without a notary.
Official source: rockwallcountytexas.com
Blank form: Download the PDF
Catalogued: Oct 5, 2026
Machine-readable: JSON record · about the forms index

What this form is

A participant uses this authorization to allow Rockwall County Indigent Health Care to speak with family members or friends about questions or issues concerning the participant’s program status. The form requests each contact’s name, phone number, and relationship to the participant, followed by the participant’s signature and date. The document does not state when the county requires the authorization or provide submission instructions.

Who needs it

A Rockwall County Indigent Health Care program participant who wants the program to discuss their client status with listed family members or friends needs this form.

How to submit it

Submit it to the county department named on the form; check the county website for current contact details.

About notarization

This document is signed and dated without a notary; it does not identify any notarized or sworn attachment or related step.

How to submit this form

1
Download the Form
Download the Authorization to Release Information.
2
Complete the Form
List each family member or friend’s name, phone number, and relationship to you.
3
Sign and Date
Sign and date the authorization. The form does not identify any required attachments.
4
Submit to the County
Submit it to the county department named on the form; check the county website for current contact details.

Frequently asked questions

What does the Authorization to Release Information allow?: It authorizes Rockwall County Indigent Health Care to speak with listed family members or friends about questions or issues related to the participant’s client status.
What information does the form request?: It requests each listed contact’s name, phone number, and relationship to the participant, along with the participant’s signature and date.
Do I need a notary for the Authorization to Release Information?: No. The document is signed and dated without a notary, and it does not identify a notarized or sworn attachment or related step.
How do I submit the Authorization to Release Information?: Submit it to the county department named on the form; check the county website for current contact details.

Need something notarized?

This Authorization to Release Information doesn’t need a notary, but Texas residents can notarize other documents online with a commissioned online notary.