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Embracing Women's Healthcare
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602.867.2690
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RECORD RELEASE FORM

Download and print the form below. Please sign
​and date the form as requested. 
cwc_recordsrelease__2_.pdf
File Size: 95 kb
File Type: pdf
Download File

Record Release Form for All Patients

We have placed a link to the necessary form for the transfer of your Medical Records either to our office or sent from our office to another entity. 
​Simply click on the PDF link to the left and download the form to complete. 
​Please make sure to sign and date as necessary.

Mail or fax the form with supporting documentation to our office.
DO NOT EMAIL your form since it is not a secure email address. Thank you. 

FAX: 602-404-1904
MAIL: 9377 E. Bell Road Unit 143, Scottsdale, AZ 85260
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