SENDMR

This page is only for sending medical records to our office

* Indicates required field

Name of the Office Sending Records *

Name of person sending records to us *

First

Last

Best phone number to call if this file has an error *

Patients Name *

First

Last

Parent or Legal Guardian Requesting these Records *

First

Last

Comment *

Upload File *

Max file size: 20MB

Submit

EMAIL ADDRESS FOR QUESTIONS ABOUT MEDICAL RECORDS

[email protected]

FAX NUMBER

407-916-4525

PHYSICAL ADDRESS

8701 Maitland Summit Blvd
Orlando, Florida 32810

UA-77455288-1