Record Release Form

Please correct the errors described below.

Request for Records Release to Julie Tomberlin MD PA

The following individual is requesting that his/her medical records be released and forwarded to our office at the address below:

I hereby authorize the release of all necessary medical records to:

Julie Tomberlin MD PA
706 Hunters Row Ct.
Mansfield, TX 76063
Phone: 682-518-8111 / Fax: 682-518-8112

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