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Medical Release

There may come a time when you are required to see a provider in a medical facility other than a Kiddy Clinic. When this happens, it’s important to supply the new provider with access to your medical records. If you choose, you may pick up your records and take them to your new appointment, or you can have Kiddy Clinic transfer them for you. In either case, accuracy and protecting your privacy are assured.

If you want us to release your information to you or to send it to another medical facility, please read and follow the steps below.

Click on the Medical Records Release form below. Once you can view the document, print a copy, then complete, sign, and mail or fax it to the Kiddy Clinic Medical Records Department:

Medical Release Form (PDF)

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