Medical Records Request Form

If you are transferring to Advanced Pediatric Associates from another health care provider, please complete the “Authorization to Release Records” form below and give to your child’s previous healthcare provider – so that we may establish a complete medical record for your child. There should be no charge to you for this service if the records are sent directly to our office. Please bring a copy of your child’s immunization record to the first visit. You may also use this form to request a copy of your medical record be transferred to a new healthcare provider.

• Authorization to Release Records

Medical records from your child's previous health care provider should be forwarded to:

Advanced Pediatric Associates
Attn: Medical Records
3300 South Parker Road, Suite 404
Aurora, CO 80014
Fax: 303-766-6903