Permission and Release of Records

The form below allows Attention MD to discuss/disclose patient care information or send records to other individuals and/or providers.

Please download, print, complete the form and email to omason@attention.md or Fax to (877) 411-1871. If emailing please send as a pdf attachment, not as an image file.

Please allow 2 business days for records to be sent to another provider. You may also fill out a Release Form with your current provider and fax us the records request.

CONFIDENTIALITY NOTICE: Email and text messaging systems do not meet the level of security recommended in the HIPAA legislation.  We make these forms of communication available to individuals who prefer convenience at the expense of security.  Phone and fax communications satisfy HIPAA regulations and are preferred.