Medical records request forms

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The form is different depending on whether you are requesting your medical records from Neurology Associates, or seeking to transfer your records from another provider to Neurology Associates. 

Transfer Medical Records to Neurology Associates

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Authorization To Release Protected Health Information (PHI)

 

2201 W. Fairview St. Suite 1 Chandler, AZ 85224

Office: 480-800-4890 Fax: 480-427-4766

Request Neurology Associates to Release Medical Records

 

Authorization For Release of Protected Health Information (PHI)

 

2201 W. Fairview St. Suite 1 Chandler, AZ 85224

Office: 480-800-4890 Fax: 480-427-4766