To request a copy of your medical records from Hanabusa IVF, please download and complete the Authorization for Release of Protected Health Information form.
This form allows us to safely and securely process your request in accordance with patient privacy requirements. Please make sure all required fields are completed, including where the records should be sent and the type of records you are requesting.
Once the form is complete, please sign it and email it to:
[email protected]
Our team will review your request and contact you if any additional information is needed before your records can be released.
Please download and print the form, complete all required fields, and email the signed copy to [email protected]
