Release of Records Forms

If you are wishing to have records from another physician released to us, please print this form and fill it out with your signature. You can then bring it to the office, mail it to the office (see address below) or you may fax it to office at (865)522-9898.

MEDICAL RELEASE TO PEDIATRIC GASTROENTEROLOGY

If you would like your records released to another physician, please print this form and fill it out with your signature. You can bring them to office, mail or fax them to us at (865)522-9898.

MEDICAL RELEASE FROM PEDIATRIC GASTROENTEROLOGY

Please be sure that the physician’s full┬áname or names and phone numbers are on forms prior to sending them to us.

Thank you.