To request outside records to be included in your Adler Family Practice medical record,
DOWNLOAD AND COMPLETE THIS FORM.  It needs to be filled out completely and signed to be valid.   A separate form is needed for each facility that will be providing records.

To us to send your Adler Family Practice records to another facility, you must complete the records request provided by that facility, and they will submit it to us.

To request your own records to be picked up by you, please send us a message using the contact form below.  Please give us approximately a week to process your records for pick up.  A valid identification is required to pick up records from our office.  Unless other arrangements have been made with your provider, only you may pick up your records.

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