Please print, complete and bring the following forms to your next appointment:

 Annual Physical Review Form

Request for Medical Records:

 Medical Record Release Form

 Formulario de Autorizacion para Dar a Conocer Informacion de Salud

All requests for medical records must be submitted in writing. Please include the following information: 

1. Patient's name
2. Patient's date of birth
3. Patient's Social Security number
4. Name and complete address of where information is to be sent
5. Dates of service and type of information to be sent
6. Patient or guardian signature and date
7. Name and telephone number where you can be reached
8. Reason for request

Please mail or fax your written request to:

Requests will be processed in 7-10 business days; a processing fee may be charged.