의사분들을 위해
Request Medical Records (Patient Request)
Use the form below to request a copy of your medical records. We strive to respond within one business day. We can only email records to the email address we have on file — if you need records sent to a different email, please call us at (877) 775-3377.
Please Note
- We strive to respond to requests within one business day.
- We can only email records to the email address we have on file. If you need records sent to a different email, please call us at (877) 775-3377.
이 양식은 Jotform의 HIPAA(미국 의료정보 보호법) 준수 서버에서 호스팅됩니다. 양식에서 특별히 요청하지 않는 한 민감한 의료 정보를 포함하지 마십시오.