About VA Form 21-4142
- Form name: Authorization to Disclose Information to the Department of Veterans Affairs (VA)
- Related to: Disability, Health care
- Form last updated: May 2023
When to use this form
Use VA Form 21-4142 to give us permission to obtain your personal information from a non-VA source like a private doctor or hospital. Examples of personal information may include your medical treatment, hospitalizations, psychotherapy, or outpatient care.
Downloadable PDF
Download VA Form 21-4142 (PDF)Online tool
You can submit your authorization online instead of sending us the paper form.
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