Release of Medical Records

Please read this entire page carefully!

To transfer your medical records to a new physician, you will need to complete a medical release form.

As this office is no longer in operation, paper and digital copies are not available. We will fax your medical records to your new provider. See the instructions below.

Your medical records cannot be released without a written authorization from you. Please be sure to comply with the process as outlined below.

Important: Any additional requests for medical records must be obtained from your new provider!

Download: Release of Medical Records to Patient Form.pdf

Please fill out the relevant spaces in the medical request form and mail it to the address listed below to have the records faxed to your new provider. There is no charge for this service.

Please do not request a PDF copy as this service is no longer available.

Bartlett Pond Family Medicine
P.O. Box 104
Berlin, MA 01503

To obtain information regarding HIPAA please visit http://www.hhs.gov/.

The contents of this website are © 2013 by Bartlett Pond Family Medicine, Inc.