MEDICAL RELEASE RECORD FORM
IMPORTANT: Please use the payment tab above to pay for the records you are receiving. Be sure to include the date of birth, and full name for every patient. Charges for medical records are defined under Colorado State law. The cost for an abbreviated version of your medical record is $22.50 per patient – this includes the most recent Well Visit, any current medications, your growth charts, and your immunization records, any known allergies to any medication and any recent visits for ongoing medical concerns with our office. If you would like to have copy of your entire medical record, make an initial payment of $40 per patient and we will notify you based on how large the record is if any additional charges are needed or if you are due a refund per state guidelines.
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