Patient Forms

Office Forms:

  • For controlled medications to be sent to our pharmacy for home delivery

Needing To Get A Copy of Your Medical Records?

  • Please fill out a Release of Information (ROI) below and send it back to our office.
  • If you are needing a copy for yourself, please fill out the “From TPA to other Facility” ROI. When sending medical notes to another Doctor’s there is no charge for 20 pages or less.
  • When obtaining a copy for personal records, there is a $25 fee for the first 20 pages, 0.25₵ each for every page after that. Pick-up in the office there is no additional charge, if needing it to be sent to you, there is an additional $8 fee.

*Please Note: There is a two week time frame for records to be processed, approved, and sent out. We CANNOT Fax Records.*

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