Pediatric Medical Records Request

Medical records will be released within 14 business days of receipt of a signed written request. As a professional courtesy, we will release records from one provider to another at no charge, on one occasion only. All outstanding balances on the patientís account must be paid in full prior to the release of records. Parents requesting records for themselves will receive one copy free of charge, provided that there is no outstanding balance. Medical records will not be mailed, other than to other medical providers. Parents requesting additional records for themselves will be charged $1.00 per page for the first 25 and $0.25 per each additional page.

Parents/Patients requesting shot records and physical (blue and yellow) forms will receive one copy of each for free per well child visit. If additional forms are requested, there will be a charge of $5.00 per form. We appreciate your understanding since the completion of these forms is very time consuming for our staff.

Any records needed for attorneys must be requested by the attorney with a signed request. If the records are not requested by the attorney, we will assume they are for the patient and record charges will apply as described above. The records will not be released to the attorney until payment of the invoice for records has been received by our office, as record charges will apply.

Please download and complete the medical records release form and return it to our office.