Medical Record Requests

• If you need your child’s medical records.
      Please fill out, and mail/fax/ or drop off our Medical Record Request Form.
• All records are provided on CD only and there is a fee of $20.
• Please note there may be an additional record retrieval fee of $30 if your child’s chart has been stored off site due to account inactivity of more than two years.
• Requests can take 7 to 10 business days.

Immunization Record Request

• On your first visit, we provide you with a record listing your child’s immunizations. 
• To obtain a copy of your child’s immunization records, please fill out and mail/fax/or drop off our Medical Record Request Form.
• Records will be provided and can take from 2 to 3 business days.
• If you have requested that these records be mailed or faxed, our fee for this service is $5.  If you choose to come into the office and pick them up, there will be no fee.

*Please note that for those patients 18 and over – You must complete and sign these forms yourself.  If you are not transferring your records to a new provider we require that you pick them up yourself.