Medical Records Release

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Medical Records Release

If you prefer to download this form in PDF format, please download here

To protect your privacy in accordance with HIPAA standards, photo id must accompany your request for release of your medical records. If you are faxing this form to our office, please include a faxed copy of a photo id that also contains your signature (ie: driver’s license). If you are presenting this form in person, please be prepared to present photo id which also contains your signature.

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