This form is for informational inquiries only. We do not make appointments through this form. We do not send medical advice or consultations through this form.

Attorneys and insurance companies must not communicate with us using this form.  All requests for medical records must be submitted on HIPAA compliant letters from your office and sent to our secure fax line.  Contact our office for the fax number.  Requests will be handled once payment is received, based on our invoice. Turnaround is at least 2 weeks.




    Contact Our Office

    Phone: 239.939.3303

    Visit: 13450 Parker Commons Blvd., Suite 103, Fort Myers 33912

    Mailing: 6900 Daniels Parkway, Suite 29-173, Fort Myers 33912