Third Party Medical Records Request
**Completing this form does not guarantee the release of patient medical records. Patient’s are required to provide written consent in order for medical records to be released.
To make a third party request for medical records please complete the following:
Complete the Third Party Patient Health Information Request.
Complete a Business Associate Agreement once sent to you.
Once completed, please contact our offices at:888-984-2523 to ensure receipt of the request and allow 7-10 business days for your request to be completed.