Medical Records Release

Complete the form below to authorize the release of your medical records from Pink Lotus Breast Center to either yourself or a third party, such as a medical center or insurance company. All areas on this form noted with an * are required and must be filled out. This form, and all information you are submitting to us via this form, is secure and fully encrypted.

Free Patient Resources

Make sure to tell your patients about Pink Lotus Power Up – the most comprehensive breast cancer community and resource site.

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