Record Release
  • Records Release

  • We are committed to protecting your privacy and ensuring your access to your eye health information.

    Patients may request a copy of their optometric records at any time. This form allows us to release records either to you directly or to another healthcare provider or facility as specified.

    Please allow up to 5 to 7 business days for processing. If records are needed urgently, please let us know – we will do our best to accommodate your request.

    There is no charge for electronic records. For paper copies, a nominal fee may apply in accordance with state guidelines.

    Records will be available through the patient portal. They can also be delivered by fax or mail depending on your preference.

    If you request to receive your records via email or text, you understand that standard email and text messages are not considered HIPAA compliant methods of transmitting Protected Health Information (PHI). We can provide information by other alternatives including secure patient portal, postal mail, or in person pickup. By using email or text, you accept the associated risks including the potential for unauthorized access, lack of end-to-end encryption, and possible exposure of health and billing information to unintended parties.

    If you have any questions, please contact our office.

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Date*
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