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

Return the form by doing one of the following:

• in person at 10631 S. 51st Street, Suite 1, Phoenix AZ 85044

• Fax to 844-526-2649

• email completed form to office.staff@pillerchilddevelopment.com

 

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.