Please send completed forms to

Records Request

We take our obligations to protect the information of our patients very seriously.  Federal HIPAA regulations and NJ State Law is what governs what we can release.  These are STRICTLY adhered to. We MUST receive the relevant form(s) below signed by the patient releasing his or her records or a guardian, legal representative or family member possessing proper authorization such as a valid Power of Attorney. The only format approved to release this information is signed originals of the documents below.  A Universal HIPAA form is not acceptable as these forms are what have been approved by our attorneys. 


If the request is being made by a Guardian, legal representative or individual with Power of Attorney, we require written proof of this authority before releasing records.