If this is a medical emergency, please dial 911.
If you have a non-emergent medical question,including prescription refills, please contact your primary care provider. |
Medical Record Authorization Information:
Click "download file" to the right to download a record release form
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If you did not contact us with a signed formal record request prior to October 29, 2015, your records can be obtained by the following method:
Sending an email request to our email address at: [email protected] |
*If you are unable to download the above record release form, please include the following information in your request:
Your name, date of birth and phone number Please add the following statement to your request: I hereby authorize New England Endocrine and Thyroid Center, PC to disclose my protected health information to: Doctor name: _________________ Doctor address: _________________ Doctor phone: _________________ OR Please mail my medical records to my home at: Street Address City, State, Zip Sign and date your request Once we receive your signed written request, we will forward the records to your designated physician or to your home. |
PLEASE NOTE:
Your Primary Care Physician has previously received copies of my letters of your visits with me and should not require a copy of your records.
Your Primary Care Physician has previously received copies of my letters of your visits with me and should not require a copy of your records.