| |
|
There may be an occasion when you wish to request your Medical Records. We are happy to assist you in that process.
To request your Medical Records, visit this link for MediCopy, the company we use for Medical Records requests:
CLICK HERE TO REQUEST YOUR MEDICAL RECORDS
Follow the instructions on that page to complete the MediCopy Authorization for Release of Medical Records Form, which you can submit online, by email, or you may print it and submit it by fax or mail - just follow the instructions on the page.
A fee may apply.
Other Fees:
Please note there is a $30 fee per form ($15 per each subsequent form) that requires completion by our office. Examples include: FMLA and disability forms.
Please click below for disability form information.
PATIENT FORMS
|
|
|
|
Authorization for Release or Access of Protected Health Information
|
Download |
|
|
|
|
Disability
Information Form |
Download |
|
|
|
|
Notice of
Privacy Practices |
Download |
|
|
|
| |