Radiology Regional Center Form Request

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Serving Southwest Florida for over 35 years. Telephone: 239.936.2316

Request Authorization for Release of Medical Records Form

Please use this form to request an Authorization for Release of Medical Records be MAILED to you.

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Radiology Regional Center - serving the diagnostic needs of Ft. Myers, Cape Coral, Lehigh, Bonita Springs, and Naples, Florida
with X-Ray, MRI, CT, PET, Ultrasound, Mammography, Nuclear Medicine, and Health Screenings.

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