Complete the below medical record request form, pay the processing fee, and email the completed form to info@panditmd.com
Records will only be faxed to the number listed on the emailed form.
Please allow up to 5-10 business days to process the records request.
Please note, there is a nominal $20 fee for processing records requests.
Please use the link below to process payment.
1. Download this form.
2. Fill in and sign form.
3. Pay form processing fee.
4. Send completed signed form to info@panditmd.com
Medical Records Release Form (pdf)
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