Leave the first line as entered. In the second line, add the Doctor’s name and address to whom you want your records sent.
Then, you can add any pertinent information after that entry. All fields must be completed. Incomplete forms will be ignored, and you will not receive any notification. You are responsible for completing the form correctly.
Please allow up to 10 business days for receipt of records.
By submitting this form, you are agreeing to Warner Robins Ob/Gyn, LLC policies of data usage and acknowledge that the recipient, you have listed herein, may receive confidential health information contained in our records about you without any limitations.
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Please Note: Record requests will be fulfilled by a file transfer service to accommodate size of records. You will only need to follow the link to obtain your records. However, the records will be available for a few days and should be downloaded right away. All requests made on or after June 30, 2021 are provided free of charge one time for each patient to the email address of their choice. Additional requests will require a prepayment of $150.00 per request. If prepayment is required, you will receive an e-mail giving you instructions and the ability to make the payment. This also will apply if you fail to download your records in a timely manner and need another copy. Medical Record Policy |
