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 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.