Your Medical Records

Your medical records can be released to you or anyone you authorize by completing the Authorization to Release Information Form. The patient or patient’s legal representative must sign and date the consent form. You have the right to revoke authorization at any time by submitting it in writing to the center.

The form can be submitted via USPS Mail, fax 248.265.4635, email medrecords@unasourcesurgery.com, or by physically dropping it off at the center. Please include how you would like the records sent. (Please keep in mind that emails sent over the internet may not be secure.)

We strive to meet a 7-10 business day turnaround time but please allow up to 30 days for processing as permissible under HIPAA.

Medical Records Department

Phone 248.265.4630

Fax 248.265.4635

Email medrecords@unasourcesurgery.com