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.

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




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

FAX #: