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Documentation Requests

NOTICE:  if you are an established & current patient , use this form to request a letter or report regarding diagnosis, recommendations, and/or accommodations, preparation can take between several hours and billed at the doctor's hourly fee.


If you need a brief summary for a diagnosis, treatment progress or medication recommendations, this may be subject to a fee depending on the time required to complete the letter.  Please allow us at least a few weeks notice for requesting any reports.

Requesting Documentation- Existing Patients ONLY
I am requesting the following:

Thanks for submitting!

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