MEDICAL RECORDS RELEASE FORM
You may use this form to request your medical records from Copper Ridge Surgery Center. Please be sure to complete the form in its entirety including name, address, and your signature, as well as the fax number, email or mailing address of where the records are to be sent. The form can then be sent back to CRSC using any of the following methods:
Email:
Note: Using this email link will transmit information from your personal email address to medicalrecords@surgerytc.com Email sent from your personal email address may not be secure. Please be aware of this risk when sending Protected Health Information (PHI) covered under the Health Insurance Portability and Accountability Act (HIPAA) in this manner.
Fax:
231-392-8973
Mail:
Copper Ridge Surgery Center
Attn: Medical Records
4100 Park Forest Drive
Traverse City, MI 49684