Comprehensive Endocrinology, PC
240 W Passaic Street, Suite 14, Maywood NJ 07607
Telephone: (201) 903-0070 Fax: (201) 322-0287
Dr. Ari Geliebter - Dr. Rebecca Geliebter
I hereby request protected health information to be released from the medical record of:
I hereby authorize and request the prompt release of medical records without exception, including but not limited to clinical notes, lab tests, pathology reports, radiology reports, messages, prescriptions, consultations and secondary records.