Patients needing their medical records from our office will receive their records within two weeks after signing a Release of Information Consent form. If this is an urgent request, please indicate so when you call the Medical Records Department at (765) 642-8477 Ext. 26. If you need your records sent to another physician for an upcoming visit, please have that doctor's office call us with the specific request and your records will be sent directly to that doctor's office.

The following medical record requests will be completed and mailed within a 30-day period and will cost $15.00 for the 1st 10 pages and .25 cents per page for pages 11 and more. The requests are as follows: Insurance Company requests including Medicaid, Attorney requests, Social Security/Disability requests and any other 3rd party requester.

Requests from another doctor's office or facility for patient records must have a signed Release of Information Consent form from the patient with the request. These may be faxed to (765) 646-8810. If a doctor's office or facility has a specific question about patient records, please call (765) 646-8477 Ext. 26. If a doctor's office or facility only needs a specific lab, x-ray, etc., no signed consent is necessary and that information will be faxed immediately.

Our information is available in a PDF format. If you do not have Acrobat Reader,
please click the icon to download.

We ask that our patients fill out the Medical Record Request Information form.

You may read it in the office on your next visit or you can download it from our site.

[Click Here to Download a Printable PDF file]