Medical Release Form

To request medical records please click here to download and print the medical release form.

Return the form by doing one of the following:

 

Releasing of medical records costs:

  • First 10 pages are free/ calendar year

  • Records over 10 pages costs $15.00 + .25/ page over 10 pages

  • Records can be picked up in person (with identification) or mailed *certified mail.

  • *Records mailed will be charged certified mail postage in addition to any processing fees.

To Schedule An Appointment

Call 480-398-4280​