Medical Records

*Please note that requests require seven (7) business days of processing time.

Please fill out this document and attach to the form below.

The following health information that relates to all services rendered at Brinton Vision may be released:

  • Entire Medical Record including patient histories, office notes, test results, referrals, consults, and records sent by other healthcare providers.
  • Patient History
  • Office Notes
  • Test Results
  • Referrals
  • Consults
  • Records Sent by Other Health Care Providers

"*" indicates required fields