Please check all that apply in the following:
The Release of Information will remain in effect until terminated by me in writing.
The best time to reach me is (day) day between (time) time
STEVEN I. CURTISS, M.D.SCOTT F. ROSEN, M.D.JEFFRY ZAVOTSKY, M.D.
MEDICAL RECORDS RELEASE
I, hereby authorize you to release copies of my medical records to Surgical Affiliates of NJ (Highland Park Surgical Associates). Please send any reports of my diagnosis and records of treatment or examination as well as any labs and/or radiology.