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MEDICAL RECORDS REQUEST

Please fill out the request form below and one of our staff members will be in touch.  

By submitting this form, you acknowledge and agree that the information provided will be used solely for the purpose of processing your request for records. OptimuMedicine is committed to protecting your privacy and ensuring the confidentiality of your personal data. All information submitted will be handled in compliance with applicable privacy laws and regulations. Please do not include sensitive or confidential information beyond what is necessary for your request.

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