FAMILY & GERIATRIC MEDICINE

ADVANCED WOUND CARE

HYPERBARIC OXYGEN THERAPY

FAMILY & GERIATRIC MEDICINE AND ADVANCED WOUND CARE CENTER

P:346-762-8822 | F:713-583-0708

HMS.ELDRIDGE@HELIUMMEDICAL.COM

146 ELDRIDGE, STE B, SUGAR LAND TX 77478

FAMILY & GERIATRIC MEDICINE AND ADVANCED WOUND CARE CENTER

FAMILY & GERIATRIC MEDICINE AND ADVANCED WOUND CARE CENTER

Medical Record Request Form

AUTHORIZATION TO REQUEST MEDICAL RECORDS FROM PREVIOUS PROVIDER

I hereby authorize: Dr. Edith Akintokunbo to receive my medical records.