NORTHERN FERTILITY & REPRODUCTIVE ASSOCIATES P.C.
Board Certified Endocrinology and
Infertility
Martin F. Freedman, M.D.FACOG
Arthur J. Castelbaum, M.D.FACOG
SEND THIS RELEASE FORM TO YOUR PREVIOUS OB/GYN DOCTOR
To:  |
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I hereby authorize and request that you release my complete medical records in your possession to: |
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Martin F. Freedman,
M.D. |
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My appointment is scheduled on |
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office. |
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Thank you for your prompt attention. |
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Signature |
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| Address |
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State
Zip Code |
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| Holy Redeemer Medical Office Building 1650 Huntingdon Pike, Suite 154 Meadowbrook, PA 19046 TEL. 215-938-1515 FAX 215-938-8756 |
Abington Court Apartments 1300 Old York Road, Bldng E-4 Abington, PA 19001 TEL. 215-5721515 FAX 215-572-7090 |