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Transfer of Records Request Form
If you have previously seen a podiatrist and are transferring to Texoma Foot and Ankle Specialists, please complete the Transfer of Records Request form and return it to our office in-person, by fax to 903-463-7711, or by e-mail to firstname.lastname@example.org. We will send the form to your previous podiatrist to obtain your previous records and avoid unnecessary duplication of procedures or treatments.Transfer of Records Request Form
Patient Records Request Form
In accordance with HIPAA regulations, patients may request copies of their records as needed. We do require 72 hours advance notice to process your request, and a fee of up to $25.00 may be required before documents are released. Please complete the Patient Records Request form and return it to our office in-person, by fax to 903-463-7711, or by e-mail to email@example.com. This form can also be used to request a copy of records to be released to a third party; please designate the recipient in the appropriate area of the form. If you only wish to review your medical chart without obtaining a copy to release, you may do so free of charge by scheduling a time with our office biller.Patient Records Request Form