To request a copy of your records, please click on the link below.  You may print this form and either drop it off at the clinic or mail it.  Please request your records by August 15, 2019.  Patients will be notified when their records are available for pick up.

After August 15, a $5 fee will be charged for a copy of your records.  If you would like your records mailed, a prepaid postage fee is required.  

Due to the high volume of records that need to be processed, some patient records will not be available until after the clinic closes.  The clinic will be open specific hours for record pick up.  Please listen to the phone message after August 31 for times.  Thank you.

Records Release form