Transfer of Records Request

We appreciate your interest in a records transfer. If registering multiple patients, you must complete a request for each patient transfer or records request.

Step 1:

Fill out the form on this page and click “Submit & Sign Transfer Agreement”.

Step 2:

On the following page, fill out all of the required information, then digitally sign the request.

Step 3:

Print or save a copy for your records.

OPTIONAL:

If you are transferring more records, come back to this page and repeat Steps 1-3