Medical Records Release

To have your former physician’s office release your child’s records, please complete this form and fax it to your former physician:

Release of Records

You’ll also need to complete this form if you want to authorize our office for a medical records release regarding those kept at MD Pediatric Associates. Fax completed forms to us at (469) 671-5437.

If a former patient is over 18, we will need a signed Adult Authorization form to release records to mom or dad.

To request a shot record or a copy of a previously filled physical form, please use log into your Patient Portal.  If you have not received an invitation to be a proxy for your child on our Follow My Health patient portal, please email with your child’s name and DOB and we will send you an invitation.

"We like MD Pediatrics because everyone in the office is friendly, the doctors are great, and if your child is sick, they will get your child into the office that day to see someone."

- Andrea P

        Super Docs 2017                         Suburban Parent Best of 2017

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