Get Greg A. Cisneros, M.d. Medical Records Release Form

Filling out the Greg A. Cisneros, M.D. Medical Records Release Form online is a straightforward process that enables you to request the release of your medical records efficiently. This guide will help you navigate each section of the form to ensure you complete it accurately.

Follow the steps to fill out the medical records release form online.

1. Locate and press the ‘Get Form’ button to access the Medical Records Release Form, ensuring you have the document ready to fill out online.
2. Begin by entering the current date in the designated field at the top of the form, ensuring that it reflects the date you are filling out the request.
3. In the next section, provide the name of the doctor or facility from whom you are requesting records. Make sure to write 'Greg A. Cisneros, M.D.' in this field.
4. Enter the address of the doctor or facility, which is: 33 Old Kings Road North, Suite 2, Palm Coast, FL 32137.
5. Indicate the specific records you want released by checking the appropriate boxes for EKG, Labs, Imaging Reports, or any other special reports from the past year.
6. Provide your name in the 'Patient Name' field, making sure it matches the name on your medical records.
7. Fill in your address in the 'Address' fields, ensuring both are complete and accurate.
8. Input your date of birth in the specified field to help verify your identity and link the records to you.
9. Sign the form in the designated signature area, authorizing the release of your records to Greg A. Cisneros, M.D.
10. Finish by reviewing all the information on the form for accuracy. After completing the form, you can save changes, download, print, or share it as needed.

Complete your medical records release form online today for a smooth and efficient processing experience.