Lakewood (216) 227-3333
Middleburg Heights (440) 845-8290
Office Hours: Monday – Friday 8am – 5pm By Appointment Only
I hereby request and authorize the release of all information, without limitations regarding any physical and mental condition, as revealed by your observation or treatment, past, present or future.
This includes medical, surgical and dental history, x-ray findings, diagnosis, prognosis and access to all hospital records and photocopies of the same.