MEDICAL RECORDS

TRANSFERRING MEDICAL RECORDS In

To have your medical records transferred to our practice from another medical office, please complete this form and send it to your previous doctor's office.

TRANSFERRING MEDICAL RECORDS OUT

If you would like us to send your Modern Dermatology medical records to another physician, please complete this form and send to info@moderndermct.com

TO REQUEST A COPY FOR YOURSELF

If you would like a copy of your Modern Dermatology medical records, or those of a minor in your care, please complete this form and send to info@moderndermct.com