Patient Portal Access

Medical Records

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A paper copy of your medical records can be requested via the attached form (see below).  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 and processed.  Additionally, please review the fees (see below) associated with copying and mailing your medical records. Contact us via phone, mail, or patient portal if you have any questions. 

Patient Authorization to Release Medical RecordsPlease print and complete the form in its entirety. Make sure the form is signed and dated. Fax back to office at 570-348-1109.
Medical Records Fee

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