Medical Records Request

You may request all patient medical records here:

Step 1: Click the link below to download our medical records release form. Please fill out the form entirely and email the completed form back to frontdesk@mypedeyedr.com. 

Step 2: Once you have emailed your completed medical records form to us, please click the link below to pay for your forms. ***When filling out the payment information please provide the email address and PATIENT’S NAME so we know who exactly we are sending medical records and where. The cost is $40.00 per patient.  Improper payment will delay your records.

https://buy.stripe.com/5kA14e4XJ8aI83mfYZ

Step 3: The medical records will be sent by email to the email you provided. Please text- DO NOT CALL- our office number if you need to check on status. There is limited message availability.