Instructions for Requesting Medical Records

1. Please download and print the PDF Form located here:

Medical Release PDF Form

2. Complete and sign the form in black ink and email the form to:

* Note: A patient's referring physician or primary care physician received a copy of the medical record following every office visit.
* Request for medical records takes 30 days to be enacted due to accessing storage.
* All records requests must be properly notarized for us to insure that HIPAA compliance regulations have been met.
* Cost of records is $1.00 service charge per page. If the records are to be mailed, there is an additional cost of $6.00 per every 50 pages.
* Requester of the medical records insures that whatever location the records are forwarded to is fully HIPAA compliant.

Copyright 2015 OAC, Inc.