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Patient Forms

Medical Records Release Form

Please download and complete the following form if you wish to have your medical records.  This form may be used for medical records to be sent to you, another provider, or hospital.  We will be unable to process incomplete forms.  Please allow 10 business days for medical record requests to be completed.  Depending on the extent of your request, there may be a fee associated with processing.

Authorization for Release of Information


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