Medical Records Release
If you've previously received dermatological care elsewhere, obtaining your medical records before your appointment helps our providers better understand your medical history and continue your care.
To Request Records from Another Provider:
Download and complete the Medical Records Release Form below, then send or fax it to your previous provider.
Please call our office before your appointment to confirm that we've received your records.
CONSENT FOR RELEASE OF MEDICAL RECORDS TO BELLEVUE LASER CENTER
To Request your BLCC Records:
If you would like Bellevue Laser & Cosmetic Center to send your medical records to another healthcare provider, please complete the form below.
Please note the following if you would like to receive your records via email.
Your privacy is important to us and we are committed to safeguarding your personal health information (PHI).
However, we must inform you that any patient information sent through email is not encrypted or transmitted over a secure server. The form must include the following verbiage: I am aware that the contact@bellevuelasercenter email account is not encrypted or transmitted over a secure server. I consent to receiving the requested information via email.