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Medical Records Release

If you are an existing patient and you need your medical records to be sent to another provider, or you are a new patient to our practice and need medical records from your previous physician, please print and complete the form below. EXISTING patients, please return the form to us by Fax at 714.668.2530, drop it off in our office, or mail it to us. NEW patients, please send the form to your previous physician's office
  • Request for Release of Medical Records [PDF][Online]

Pediatric and Adolescent Medicine

1190 Baker St,
Costa Mesa, CA 92626

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(714) 668-2525

Office Hours

Monday
09:00 am - 05:00 pm
Tuesday
09:00 am - 05:00 pm
Wednesday
09:00 am - 05:00 pm
Thuirsday
09:00 am - 05:00 pm
Friday
09:00 am - 05:00 pm
Weekend
Closed

Office Hours

Monday
09:00 am - 05:00 pm
Tuesday
09:00 am - 05:00 pm
Wednesday
09:00 am - 05:00 pm
Thursday
09:00 am - 05:00 pm
Friday
09:00 am - 05:00 pm
Weekend
Closed