PATIENTS REQUESTING COPIES OF THEIR RECORDS MUST DO SO BY CONTACTING THEIR LOCAL MYEYEDR OFFICE.

Please complete this form to request medical records for MyEyeDr patients, fill out all required fields, and upload all pertinent documentation for your request. i.e., Authorization Release, Cover Page, Transmittal guidance, etc.

Please allow up to 30 business days* for your request to be processed and completed. We will send all requested records found to the requestor via fax.

*For requests containing 25 or more patients, please compile your patient list into an Excel Spreadsheet and upload it to the appropriate section of the form. These requests will have a longer timeframe for completion.