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

FAMILY MEDICINE | GERIATRIC | ADVANCED WOUND CARE | HYPERBARIC OXYGEN THERAPY

146 ELDRIDGE RD, SUITE B, SUGAR LAND  TX 77478
PH: 346-762-8822 | FAX: 713-583-0708 | HMS.ELDRIDGE@HELIUMMEDICAL.COM
AUTHORIZATION TO REQUEST MEDICAL RECORDS

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