Records Request

The form below must be filled out in it’s entirety and faxed to our office prior to the release any records.

Please do not call our office to ask for a release of records. Instead, please download this form, fill it out completely and fax it to our office at (610) 383-7968.

There is a charge to copy and send records. We will let you know how many pages your record is and how much the cost is to copy it. You will receive an invoice. Once the invoice is paid we will send your records to you.

If another physicians office is asking for the records, the patient cannot receive the records on their behalf. Please ask the physicians office to call our office and select option nine.

Return to Home Page