MEDICAL RECORDS REQUEST

NEED YOUR MEDICAL RECORDS?

  1. Download Request Form

  2. Complete Request Form

  3. Fax or Email Completed Form

*There may be a cost associated with processing your medical records.
DOWNLOAD REQUEST FORM

Fax: 586.722.0201
Email to medicalrecords@synergyhealth.org
This authorization form can also be dropped off at the front desk of the office the patient is seen at.