Should you need your medical records sent to or from our clinic, fax or
mail this completed form:
Authorization for
Disclosure of Patient Health Information Form
Alexandria Clinic, P.A.
Attn: Medical Records
610 30th Ave West
Alexandria, MN 56308
Fax: (320) 763-7883
You will need a PDF reader such as
Adobe Reader
to view and print this form.
If you need help filling out the form, contact our medical records
department at (320) 763-2501. The records will be copied within 5
days of receiving your request. If you have requested them to be
picked up from the clinic, please note who will be picking them up if it
is other than yourself.
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