Patients and Physicians: Click here to download a medical release form.
Complete the form above and email email@example.com.
Our medical records custodian will contact you when your records are prepared. We are happy to email you your records from our secure portal, or you can pick up a printed copy at our local clinic. When you receive the message from our secure portal you will click on the link and follow the simple instructions to access your documents.
Our fee for form completion is $25.00. Completed forms will be released within 3-5 days of credit card payment.