I authorize:
NorCal Dermatology and Cosmetic
Khanh Truong, MD; Henry DeGroot, MD
196 Wikiup Drive
Santa Rosa, CA 95403
To release my medical records to:
I authorize:
To release my medical records to:
NorCal Dermatology and Cosmetic
Khanh Truong, MD; Henry DeGroot, MD
196 Wikiup Drive
Santa Rosa, CA 95403
Phone: 707-527-9917
Fax: 707-527-9913
I understand that I have the right to receive a copy of this authorization.
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