DESERT CENTER FOR ALLERGY AND CHEST DISEASES

 

THERE IS A $25 CHARGE FOR PREPARING MEDICAL RECORDS

AUTHORIZATION TO RELEASE MEDICAL RECORDS

I hereby authorize Desert Center for Allergy and Chest Diseases to release medical records and data pertaining to:

Please specify what records should be released:

  

Please specify method of release:

          
  

Please be aware that if there are more than 15 pages, records cannot be faxed.