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For information on our advanced safety measures for receiving care during the COVID-19 pandemic, click here.

Payments for Copies of Medical Records

Please complete the below form with the corresponding information from the invoice you received from Capital Health. Once payment has been received, we will process your request for records. Please keep a copy of the payment transaction for your own record.

Patient Information

Required information is indicated by a red * before the label

Requester Information

Billing Address