Medical Release Forms

• Pregnant Patient Transferring Care to The Group - OB Transfer Records Release Form
• Records Request TO The Group (request records be sent to The Group) - Medical Records Release Form
• Records Request FROM The Group (request records be sent to someone else or yourself from The Group) - Medical Records Release Form
• MAMMOGRAPHY (request mammogram records be sent to The Group) - PRIOR RELEASE FORM

If you would rather not submit this form electronically, you are welcome to fax or drop off the completed Medical Prior Release Form at our office at 5350 Eastern Ave., Davenport, IA or FAX to 563-359-1512. However, if you prefer to submit this form electronically, you can do so using the above links.