Medical Record Request Form

To obtain medical records from PM Pediatrics please follow the below steps. The records will be sent to the patient’s portal unless otherwise indicated. The patient portal can be accessed here. If you have any questions please leave a detailed message for the records request department at 516-207-7960.

If you are looking to retrieve your COVID test results or other lab results, please visit your patient portal or call the office where you or your child received the test. This form is for medical record chart requests.

If you would like to obtain a copy of medical records, we ask that you complete the following steps:

1. Print the AUTHORIZATION FOR RELEASE OF HEALTH INFORMATION form.
2. Complete the form and provide a valid signature. Your signature must appear on the form to be considered valid. Electronic signatures are not accepted.
3. Send completed form and a copy of your photo ID to recordsrequest@pmpediatrics.com.