Records Request
Visit notes can be viewed within the patient portal. Contact our front desk to get access. Please fill out the following form to request a printable version of your visit notes or other documents to be emailed. Please allow up to 10 days for completion.
Full Name of Requestor
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Group Home or Facility Name
Name of Patient(s)
*
Type of Records Requested
*
Upload pertinent files (power of attorney, photo id, etc)
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