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Patient Records Request

How to Request Records:

1. Download, print and complete the authorization form. The authorization form must be signed and dated.  

2. Return the release in person to your provider or contact the provider for the individual offices email. Please note, if you are emailing, please confirm that the provider has received your email. 

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Want to schedule an appointment? Contact us now!

Sensitive information should not be emailed. Please contact our store to send information that needs promot attention. 

*Pay later available with a valid injury claim, contact store for details.

** Not all services may be available in your area.

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