If you would like us to retrieve your records from your old practice please fill this form in its entirety
If you would like us to release your records to your NEW practice, please fill this form.
Please note that release of record may take up to 3 business days from the time we receive your faxed consent form.
We do charge 75 cents per page for the entire chart.
The vaccination record will be sent out at no charge.
Medical Release Form
If you would like us to retrieve your records from your old practice please fill this form in its entirety
If you would like us to release your records to your NEW practice, please fill this form.
Please note that release of record may take up to 3 business days from the time we receive your faxed consent form.
We do charge 75 cents per page for the entire chart.
The vaccination record will be sent out at no charge.
Medical Release Form