The Orthopaedic Group
Patient Consent for Release of Health Information
Dates of Service Requested: From Date to End Date Office Visit Procedure/Operative Report Labs Physical Therapy Billing Records Injections Other:
There will be a processing fee for any records requests that are being released to a patient, insurance provider, or attorney. There is no charge for records being sent to a healthcare provider.
Patient Name / Personal Representative
Your medical records request will be processed by our partner company Acton Corporation. If you need assistance or have a question please call 205-408-6030.