Medical Records Release Form
By signing this form, I authorize you to release confidential health information about me, by releasing a copy of my medical record, or a summary of a narrative of my health information, to corridor Family Eyecare listed below:
Corridor Family Eyecare
5350 Blvd. Ste. 100
Cedar Rapids, IA 52404
319-365-2946 Office
319-365-2948 Fax
www.CorridorFamilyEyecare.com