Henry J. O'Neal, M.D., P.A.
3500 Fletcher Ave. Suite 301 Tampa, FL 33613 Phone: (813)971-2351 Fax: (813)971-1636
AUTHORIZATION OF RELEASE OF MEDICAL INFORMATION
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I hearby request a release of all my medical records to include all: (check the boxes for all that apply)
Progress notes (past 2 years)
Labs (past 2 years)
Consults (past 2 years)
Diagnostic studies includes (x-ray, radiology, colonoscopy, ultrasoungs (past 7 years)
Henry J. O'Neal, M.D., P.A.
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