Medical Record(s) Attachment
Please use this page to send records you would like us to keep up to date, including ER, specialty department, routine/annual care, lab work, and updated vaccinations.
Client Name (as it appears in the medical record)
*
First Name
Last Name
Patient Name (as it appears in the medical record)
*
Attach Records Here:
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Accepted File Types: pdf, doc, docx, xls, xlsx, csv, txt, rtf, html, zip, mp3, wma, mpg, flv, avi, jpg, jpeg, png, gif
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Would you like a confirmation email that records were received?
*
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Email
example@example.com
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