I hereby request and give my permission for the provider or hospital listed below to release my medical records to Resurgia Health Solutions so they can better understand my medical history and provide medical care.
Please securely transmit my medical records to Resurgia Health Solutions using any of the options below:
Via secure email to
By Fax to (404) 445-5173 or,
By Mail to:
Resurgia Health Solutions
1100 Peachtree Street NE,
Atlanta Ga 30309
Please contact Resurgia Health Solutions at (404) 445-5304, X-6, OR at email@example.com with any questions.