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Authorization To Release Record

Requests for Medical Records

We would be more than happy to make copies of your records!

So we may comply with your request...

Please understand that with any profession, the physical record belongs to the practice but the information that it contains is yours. This means that you are entitled to copies of your records but not the actual physical records themselves.

Because of this, there are charges. You are entitled to 10 printed or faxed copies at no charge. Any further copies will be charged at 65 cents per page. This helps us offset the cost per page, postage, and employee time. We receive a lot of requests since people move a lot nowadays and patients like us to share information with their other doctors.

This cost will be assessed for any communication with other professionals (such as ODs, MDs, attorneys, etc.), if you pick up records in person, or if you would like records mailed or faxed. Professional letters will not be assessed a charge (they are generally under 2 pages), unless there are lengthy attachments.

Review the statute below.

I acknowledge that I have thoroughly read this document and have had all my questions answered. Please allow me to download the records release form.


Exclusive Offer

New patients receive free consultation.

THIS ---->https://proeyeonline.imatrixbase.com/online-forms/authorization-to-release-records.html

Office Hours

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I have been going to ProEye for many years and continue to be pleased and satisfied by the service and care I have received.

Nancy Deackoff
Vernon, CT

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