RECORD RELEASE FORM
Download and print the form below. Please sign
and date the form as requested.
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.
MAIL: 9377 E. Bell Road Unit 143, Scottsdale, AZ 85260