Medical Records Release Form
If you need to release medical records from us to a different provider or if you need to have a prior provider release medical records to us, please following these instructions.
1. Click the Download File link below
2. Fill out the form directly on the screen.
3. When finished, click on the down arrow key on the right-hand top of the page and choose "With your changes"
4. Name the file with your name and ROI in the file name – for example: J Smith ROI. Remember where you saved it, so you can find it for step 5.
5. Email that file you saved to [email protected]
Thanks!
Family Focused Care
1. Click the Download File link below
2. Fill out the form directly on the screen.
3. When finished, click on the down arrow key on the right-hand top of the page and choose "With your changes"
4. Name the file with your name and ROI in the file name – for example: J Smith ROI. Remember where you saved it, so you can find it for step 5.
5. Email that file you saved to [email protected]
Thanks!
Family Focused Care

Medical Records Release Form | |
File Size: | 201 kb |
File Type: |