Medical Records

1. Please complete the Consent to Release Medical Record Information authorization form making sure the following required fields are filled in properly to process the request:

• Patient’s full name (include maiden name, if applicable)
• Address
• Phone number
• Email address
• Date of birth
• Facility name where treatment was rendered

Identify the method for us to share the requested medical records by clearly indicating the mailing address, fax number, email address

2. Sign and date the completed authorization form.

3. Fax your request with all required information included to 781-647-0215

or mail all required information included to:

Monte Nido & Affiliates
Medical Records
6100 SW 76th Street
Miami, Florida 33143