MEDICAL RECORDS REQUEST

From Mendelson Kornblum powered by Synergy Health Partners

Need your medical records?

To request a copy of your medical records, please download and fill the above form out and either fax it to 'Medical records' at (586)722-0201 or 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.

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