Medical Records Submission
Please use this secure form to upload medical records. This form is HIPAA-compliant, and your information is stored securely.
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What type of record(s) are you uploading?
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Advanced Directives / Living Will
Allergy List
Blood Pressure / HR Logs
CGM (Continuous Glucose Monitor) Data
Clinical Notes - Hospital Discharge / ER Notes Genome / Exome Sequencing
Clinical Notes - Specialist Consultation
Dental / Vision / Audiology Reports
Epigenetic Age Testing
Family History Summary
Imaging & Diagnostics - Body Composition or VO₂ Max
Imaging & Diagnostics - Cardiac Testing (EKG, Echo, Calcium Score, etc.)
Imaging & Diagnostics - Radiology Reports (X-ray, MRI, CT, Ultrasound, DEXA)
Immunization Records
Laboratory Test ResultsMedication List
Microbiome Analysis
Neurocognitive Tests (MoCA, MMSE, etc.)
Proteomics / Metabolomics
Sleep Tracking Reports
Wearables (Fitbit, Oura, Garmin, Apple Watch, etc.)
Other
Patient Information
Patient's Name
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First Name
Last Name
Date of Birth
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-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Email
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example@example.com
Brief Note about Records
By uploading, you consent to share the medical records with Dr. Neil’s Concierge Medicine for the purpose of review and treatment planning. I confirm I am authorized to transmit these records. Your records are encrypted and securely stored.
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