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RECORD REQUESTS

To request a copy of your medical records, click and complete the form and release of information. The processing time for copies of records may be up to 30 days after receipt of payment, depending on the type of records and the dates of service requested.

For copies of your records/letters, you will be charged a fee: 

⬜ Electronic records: $10.00 

⬜ Letters: Flat fee $5.00 

Record Request Form

Please fill out the following form.

Date of birth
Month
Day
Year
Delivery Method
Email
Secure Download
Mail
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