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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:
in person at 10631 S. 51st Street, Suite 1, Phoenix AZ 85044
Fax to 844-526-2649
email completed form to firstname.lastname@example.org
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.
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