Medical record request

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 Medical forms/records can be lengthy, therefore medical records or forms can take up to 3 weeks to complete.  Depending on the type of records, forms, or letters, for each request, there will be a $25.00 fee charge. This is an administrative fee for certain forms, letters, and records completed by our office staff. Examples of these forms are;  health verification forms, return to work/school letters, disability forms (must-have In office visits, not telemed), and legal forms for the government. This fee is not a billed/ non-billable service and will not be billed to the insurance company. This is the patient’s responsibility or the entity requesting medical records via paper form.

Medical Record Request Fax 651-800-9859