Medical Record Release Form

How to Submit the Medical Record Release Form:

1. Click the "Pop out" Icon in the upper right hand of the PDF below

2. On that page, click the "Print" Icon Button

3. Please fill out the form in its entirety and scan it

4. Send the completed form by Fax (623-825-5200) or Email (office@apgastro.com)

Please send back as a scan instead of taking a picture