Privacy Release Form

Casework Privacy Release - Printout

Note: Fields marked with an * are required.

To begin casework with my office, please complete, print, sign and mail the form below to:

SENATOR DIANNE FEINSTEIN

ONE POST STREET, SUITE 2450

SAN FRANCISCO, CA 94104

Privacy Release Form

For Office Use Only
For Office Use Only
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For Medicare and Medicaid related requests only

  1. To complete this process, click SUBMIT button below to generate form then please print and sign form by hand (no e-signatures will be accepted.)

  2. Submit signed forms to casework@feinstein.senate.gov, by fax (415)-393-0710, or by mail to:

Office of Senator Dianne Feinstein
1 Post Street, Suite 2450,
San Francisco, CA 94104