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Release of Medical Records

To process your request, ensure this form is fully completed for Pulmonary & Critical Care Specialists of Northern Virginia, P.C. Be specific about the type of information and the date range for the records you want released. Please be aware that, by law, we keep medical records for 7 years. Allow approximately two weeks for the completion of your records request, and note that there may be charges for obtaining records for personal use.

I authorize Pulmonary & Critical Care Specialists of NOVA to release my medical records as described below:

Please select all that apply

Date Range of Medical Records

Thanks for submitting!

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