Patient Forms

Medical Records Release

Patients requesting copies of their medical records must sign a records release form. This form may be downloaded, completed and faxed to our office at your convenience. Please note that all valid records releases will be processed within a ten (10) day window when at all possible. In order to comply with Ohio state law and HIPAA regulations, we charge a per page fee payable in advance for copies sent to you or another physician. This per page fee policy is available upon request. As always, if a primary care or specialist requests portions of your record to assist in your care, there will be no charge. If you have any questions, please call our office at 614-766-2006 or contact us via our website.

• Medical Records Release Form