Medical Record Release Form

medrecordsAre you joining Hearne Vision Care from another practice?  You’ll need to download and complete an Authorization for Release of Medicaid Records form and return it to our office.  Once you’ve filled this out, you can email or fax it in using the information at the top of the form.

We look forward to serving you soon, but please let us know if you have any questions.

Download Medical Release Form (82KB)




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