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Release of Information


If you need us to work with another provider regarding your continued care, or if you are requesting that your SCC records be sent to a new provider, please FULLY complete our

UT SCC Authorization for Release (PDF to print and return)

UT SCC Authorization for Release (Fillable)

If you need help filling it out, please call the office at 865-974-2196. You must attach a copy of a valid photo ID (like your driver’s license).  When you have completed the form and have a copy of your ID, you can fax it to 865-974-7039, or save both items to a PDF and send it to