Patient Portal Access

Medical Records

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A copy of medical records can be requested via the attached form.  Please complete and fax to our office at 570-348-1109.  Our office has 30 days to respond to this request.   Please allow sufficient time for your request to be answered.  Additionally, please see fees associated with copying below.

Patient Authorization to Release Medical RecordsPlease print and complete in form in its entirety. Make sure form is signed and dated. Fax back to office.
Record Copy FeesOur office reserves the right to charge for the copying of medical records relative to these price guidelines

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