I hereby authorize the release of copies of my medical records from the North Carolina Center for Dermatology and request that they are released to:
The North Carolina Center for Dermatology, P.A.
Fayetteville Street Office Park II • 6216 Fayetteville Road, Suite 102
Durham, NC 27713
Tel: (919) 484-9551
Fax: (919) 484-0667