12221 Renfert Way

Medical records are stored at the location where you received treatment. If you or your physician needs copies of your medical records, please download and complete the below authorization form.

Authorization To Disclose Protected Health Information (English)

Authorization To Disclose Protected Health Information (Spanish)

Once you have filled out the form, please return to your location by mail, fax, or in person. 

Medical records are stored at the location where you received treatment. If you or your physician needs copies of your medical records, please download and complete the below authorization form.

Authorization To Disclose Protected Health Information (English)

Authorization To Disclose Protected Health Information (Spanish)

Once you have filled out the form, please return to your location by mail, fax, or in person. 

Medical records are stored at the location where you received treatment. If you or your physician needs copies of your medical records, please download and complete the below authorization form.

Authorization To Disclose Protected Health Information (English)

Authorization To Disclose Protected Health Information (Spanish)

Once you have filled out the form, please return to your location by mail, fax, or in person. 

Medical records are stored at the location where you received treatment. If you or your physician needs copies of your medical records, please download and complete the below authorization form.

Authorization To Disclose Protected Health Information (English)

Authorization To Disclose Protected Health Information (Spanish)

Once you have filled out the form, please return to your location by mail, fax, or in person. 

Medical records are stored at the location where you received treatment. If you or your physician needs copies of your medical records, please download and complete the below authorization form.

Authorization To Disclose Protected Health Information (English)

Authorization To Disclose Protected Health Information (Spanish)

Once you have filled out the form, please return to your location by mail, fax, or in person. 

Medical records are stored at the location where you received treatment. If you or your physician needs copies of your medical records, please download and complete the below authorization form.

Authorization To Disclose Protected Health Information (English)

Authorization To Disclose Protected Health Information (Spanish)

Once you have filled out the form, please return to your location by mail, fax, or in person. 

Medical records are stored at the location where you received treatment. If you or your physician needs copies of your medical records, please download and complete the below authorization form.

Authorization To Disclose Protected Health Information (English)

Authorization To Disclose Protected Health Information (Spanish)

Once you have filled out the form, please return to your location by mail, fax, or in person. 

Medical records are stored at the location where you received treatment. If you or your physician needs copies of your medical records, please download and complete the below authorization form.

Authorization To Disclose Protected Health Information (English)

Authorization To Disclose Protected Health Information (Spanish)

Once you have filled out the form, please return to your location by mail, fax, or in person.