Happy Little Girl

Forms

Medical Records Release Request

To request your medical records from a previous physician or specialist to be released to Vicente
Roger, M.D., and Associates, please click here to download our form. Fill out the form and fax it to the appropriate doctor.  Please also send us a copy of the form either via fax at 305-868-8292 or email at vicenterogermd@gmail.com

 

If you are requesting a copy of your child's medical records from our office please email your request to vicenterogermd@gmail.com.  In your email please include the following: your child's name and date of birth, any specific part of the record requested, and for whom the records are being requested (i.e. insurance, specialist, personal).  The copied medical records will be available for pick-up in 3 business days.  If you need the records sooner than this please contact the office directly.  A processing fee for medical records is due at the time of pick-up.

 

Mon- Fri 9 am to 5 pm

Sat & Sun- CLOSED

Tel.: 305-868-5181

Fax.: 305-868-8292

1069 Kane Concourse 

Bay Harbor Islands, Florida 33154

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© 2014-2020 by Vicente Roger, MD.,P.A.