Records & Document Requests
To submit a request for our staff to complete a document, write a letter, or complete a request related to your medical records, please complete our Document Request Form.

Once we receive your request, we will upload your completed document (s) or records into the patient portal. You will be notified that your document has been uploaded and you can download the document. Please allow 5 business days for this service.

Medical Records Release Authorization
For the release of medical records to be faxed or mailed, patients must fill it out and sign our medical records release authorization form. Please complete the release form and attach the document to the Document Request Form.

Medical Records Release Authorization Form

Fees:
Unfortunately, we can not bill insurance for the completion of forms, so we have an additional fee to compensate the provider for their time to complete the form and we pass on any additional fees associated with the transmission of the data.

• Request for Records or Treatment Plan:  $15.00 (uploaded to your patient portal)
• Add-on fees: Fax: add $.05 per page,  Mail: add $.35 per page

• Form Completion Request (FMLA, Accommodation Forms, Disability, etc.): $35.00 (uploaded to your patient portal)
• + cost to Mail document, if applicable
• Note: Must have attended 6 sessions with an LCPC/LCSW/Psy.D. or had 3 sessions with a Nurse Practitioner.  Your account must be in good standing before documents can be completed.

Please feel free to contact our Client Relations Team at (312) 279-9981 x2 for more information.