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
4245 Johns Creek Parkway
Johns Creek, Georgia 30024

Fax: 678-623-5428

Email: medicalrecords@fusionsleep.com

Authorization to Release MR from FS

Authorization to Send MR to FS

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.