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Important Information About Requesting Medical Records.

Please download and fill out completely the Authorization For Use and Disclosure of Medical Information Form.

For quick processing, please email the completed and signed form to records@synergysmg.com.

Via Fax: (858) 412-6376

Synergy Orthopedic Specialists, Inc.
Attention: Medical Records
4445 Eastgate Mall, Suite 105
San Diego, CA 92121

If you have any questions, please call (858) 357-9450, ext. 6.

This authorization allows the healthcare provider(s) named below to release confidential medical information and records. Note: Information and documents regarding the treatment of minors, HIV, psychiatric/mental health conditions, or alcohol/substance abuse have special rules that require specific authorization.

The patient or authorized representative must fill out and sign the form. If the Form is incomplete or not signed and dated, your request will NOT be processed.