Forms
Medical Release Forms
TO REQUEST COPIES OF MEDICAL RECORDS
Signature Requirement: Before your medical records can be released, patient, parent or legal guardian must complete, date and sign a release of information authorization. If the patient is 18 years or older, he/she must request the information.
Please print the Authorization to Release Protected Health Information form. After printing and completing the form, please fax, email or mail the form to the location below:
FusionSleep®
Medical Records Department
3650 Mansell Rd.
Suites 100 and 125
Alpharetta, Georgia 3002
Fax: 678-623-5428
Mode of Release: Records cannot be emailed. Records can be faxed or picked up with proper photo identification during normal business hours (8 a.m. – 4:30 p.m.). Otherwise, records will be mailed.
For questions regarding medical records requests, please call 678-990-3962, ext 256.