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Third Party Requestors

Your information will be verified, please provide your FIRST NAME, LAST NAME and your firm's shared/dedicated EMAIL ADDRESS, to expedite your registration process. Without this information, your registration will not be processed.

Patients Records Request

requires a completed and signed Authorization for Disclosure of Health Information form before releasing any documents to anyone, including the patient. Please download, fill out and sign any of the forms provided below.

Once you have completed the forms, mail or email them to:

  • 1142 S. Diamond Bar Blvd #310, Diamond Bar, CA 91765.

Emails requesting medical records must include a complete and signed Authorization for Disclosure of Health Information form.

All requests are subject to fifteen business days turnaround. PLEASE do not call during this period of time. We'll keep you posted on any further updates.