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Uthorize to release medical record information concerning the above-mentioned patient. * FROM: (Required) MAIL TO: -or- CVC Medical Records 3805 E. Bell Rd., Suite 3100 Phoenix, AZ 85032 NAME (Facility to release the information) (Address) FAX TO: 602.824.9540 Questions or Concerns: 602.795.5984 (City, State, Zip) Appointment/Continuation of Care Personal Use Pick up at Cardiovascular Consultants Clinic Location Consultation(s) Office Note(s) Echocardiogram report Treadmill Event M.
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