Records Release Authorization Form

APPOINTMENTS: (248) 856.6300
75 Barclay Circle, Suite 115, Rochester Hills, MI 48307

If you ever want to have your medical records released to any medical facility please click on the following link to view and print the form. Either mail or fax the signed authorization form for us to forward your medical records.

Records Release Authorization Form (for sending our records to another provider)

Records Release Authorization Form (for other providers to send records to us)

NOTE: If you haven't already, please install "Abobe Acrobat Reader" to view or print these forms. Please click here to download it.