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Release of Information Form

Fees 

There is no charge for records sent directly to another physician.
There is a $0.56 charge per page (plus postage) for the cost of labor and supplies for personal copies of your record provided in paper form. We do not provide electronic copies of medical records. These same fees apply to copies of records sent to other recipients (i.e., attorney’s, insurance companies).
 

 

Release of Information Form