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Interim Portal Medical Records Request Form

ATTENTION PATIENTS: Please be informed that the form below is only intended to be used TEMPORARILY starting on December 9, 2022, until the launch of the new portal in early 2023.  Only the email address linked to your portal account can be used to send records.

Please fill out the request form below if you require records during this time range ONLY and please allow 3-5 business days for processing.

To request a copy of your medical records for visits prior to 12/9/22, please visit our Medical Records page and fill out the Request for Patient Access to their PHI form per our normal request process.

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