Release of Information
Do you need copies of your medical records for tax purposes, school, or other purposes?
Please fill out and return the form below along with a copy of your ID in one of the following ways:
Mail the completed form to our Administration Office (Attn: Medical Records Department): 3875 W. Beechwood Ave. Fresno, CA 93722
Fax the completed form to our Medical Records Department at 1-855-771-5224
Drop off the completed form at any of our health centers.
Please note: The completed form must be submitted with a copy of the ID of the patient or patient's representative (whoever signed the form).
Authorization for release of Information - English