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- Click ‘Get Form’ to open it in the editor.
- Begin by checking one of the boxes at the top of the form to indicate whether you are requesting medical records copies or forms processing. Note the associated fees.
- Fill in your personal information, including your name, phone number, date of birth, and address. Ensure all fields are completed accurately.
- Specify the date(s) of service needed by entering the 'From' and 'To' dates.
- Indicate which provider at the Center for Sports Medicine you are requesting records from by writing their name in the designated field.
- Describe the information you are requesting, such as office notes or lab reports, in the provided section.
- Enter your personal email address for electronic delivery of documents. This is a required field.
- If applicable, fill out the section for releasing records to another person or entity, including their name and contact details.
- Sign and date the form at the bottom to authorize the release of your protected health information.
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