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.

You may download and print the record release form below.  Fill it out and fax to the 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.

FAX #:


Jean Holland Dermatology

Jean M. Holland, MD, FAAD