You may download and print the record release form below. Fill it out and mail it or use the fax number below:
AFTER 12-20-2019, we will fax your records to your physician's office, at no charge, within three weeks of receiving a properly executed authorization form from your new physician.
Per State of Michigan law [Public Act 47 of 2004, MCL section 333.26269], patients are entitled to a copy of their medical records and the custodian of records is entitled to charge for them. There is a state-approved fee of $5.00 for the first 4 pages, and $1.25 for each additional page. Upon receipt of a release form, you will be contacted regarding how to make payment, and after payment is received, the records will be sent.
Jean Holland Dermatology
Jean M. Holland, MD, FAAD
Latest update: After weeks trying to transfer my old Comcast fax number, I gave up. Just got AT&T, and this temporary fax number, usable immediately and thru 2-28-2020.
After 1-29-2020, our old fax number will be active.
Mailed requests will be honored; the old address at 14700 King Road, Suite B, is reliable until this summer.