Record Request Forms
Whether you’re new to our practice or need to leave our practice, you can use the forms below to facilitate the process.
Use our Records Release Form to have your records mailed over to us from your current practice.
If your child has reached the age of 24, we request they seek an adult primary care physician. We feel at that age they would be better served by a health care provider that specializes in adult health. Please fill out the Record Request Form. We are happy to have provided care for your child over the past several years.
You have the option to either have your records printed on paper, and mailed to you or have them sent through the patient portal.
Records Printed On Paper:
If you choose to have your records printed on paper and mailed include a $25 fee per child. The fee for records printed on paper and picked up from the office are $10 per child. You can call our office and we will accept payment over the phone. Once we receive this signed form and a payment, we will mail out the records.
Records Sent Through Patient Portal:
To have your records sent through our patient portal, you must have been registered with us prior to this request. Please contact us if you have forgotten your username or password and we will be glad to reset the account for you. Records sent through the portal are free of charge. Once we receive this signed form, we will send you your records through the portal.
Records Printed On Paper:
If you choose to have your records printed on paper and mailed include a $25 fee per child. The fee for records printed on paper and picked up from the office are $10 per child. You can call our office and we will accept payment over the phone. Once we receive this signed form and a payment, we will mail out the records.
Records Sent Through Patient Portal:
To have your records sent through our patient portal, you must have been registered with us prior to this request. Please contact us if you have forgotten your username or password and we will be glad to reset the account for you. Records sent through the portal are free of charge. Once we receive this signed form, we will send you your records through the portal.
Records Printed On Paper:
If you choose to have your records printed on paper and mailed include a $25 fee per child. The fee for records printed on paper and picked up from the office are $10 per child. You can call our office and we will accept payment over the phone. Once we receive this signed form and a payment, we will mail out the records.
Records Sent Through Patient Portal:
To have your records sent through our patient portal, you must have been registered with us prior to this request. Please contact us if you have forgotten your username or password and we will be glad to reset the account for you. Records sent through the portal are free of charge. Once we receive this signed form, we will send you your records through the portal.
To request your records on-line:
- Go to our Patient Portal
- Click on patient forms
- Go to Record Request Z2
- Go to our Patient Portal
- Click on patient forms
- Go to Record Request Z2
To request records using our paper form:
Fill out form below and mail it, fax it to 781-944-0232, or stop by the office to drop it off.
Fill out form below and mail it, fax it to 781-944-0232, or stop by the office to drop it off.