Request Records or Forms/Paperwork

Requests for Medical Records and Completion of Forms/Paperwork:

To request medical records and/or completion of paperwork/forms, CLICK HERE to download the disclosure authorization form and CLICK HERE to download the request form. Both forms are required prior to the release of records.

*Fees for Medical Records/Completion of Forms:

  • Copy of progress notes of patient visit(s)

    • $5.00 per visit, $35 max
  • CD of x-rays taken at Foot & Ankle Associates, Ltd.

    • $20.00 per CD
  • Completion of FMLA paperwork

    • $25.00 per form
  • Completion of disability paperwork

    • $25.00 per form
  • Completion of parking placard paperwork

    • $25.00 per form
  • Completion of other form:

    • $25.00 per form

(The *fee for service for these items is likely not covered by your insurance and will not be submitted to the insurance carrier for payment. You are responsible for the payment of these fees.)

NOTE: Payment is due at time of request

Once the full payment is received, please allow two to three weeks for completion of your request. If you need to request “Rush Processing” (available within 3 business days) an additional $25 will be charged. (This option may not always be available, so please confirm this with the Office Manager first.)

The completed authorization and request forms can be dropped off in person or mailed to our office along with the payment, or faxed (708-424-5001) to our office with a request to contact you to arrange payment via debit/credit card.

Forwarding Office Visit Notes to Other Physicians:

Office visit notes are automatically sent to your Primary Care Physician of record subsequent to each visit at no charge. For this reason, it is very important you notify us immediately if you change physicians. You may also request these notes, free of charge, to be sent to other physicians in your circle of care (such as your cardiologist, endocrinologist, etc.) You may request this by downloading the request form CLICK HERE and returning in person, by mail or fax (708-424-5001); or by submitting a request electronically through your Patient Portal CLICK HERE.

NOTE: (From the Patient Portal menu, select “Message” – “Inbox” – “Compose”.)

Online Access:

You may view your electronic medical records online. Please CLICK HERE to complete the login process and follow the prompts as instructed.

Make An Appointment

If you would like to request an appointment for a future day and time, please fill out the form below. Upon submission, a member of our staff will follow up with you directly to confirm scheduling. If you have any other questions, please contact us at (708)-954-2316. We look forward to seeing you soon!