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Marcy J. Gunn, Psy.D
Owner/Director of Child Psychology
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Jonathan M. Cleveland, Ph.D.
Director of Adult Psychology
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Chelsae Roby Pistello, Psy.D
Licensed Clinical Psychologist
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FORMS

HIPAA

REQUEST FOR ACCESS TO MEDICAL RECORDS

You have the right of access to your medical records. Please use this form to make your request in writing. Our office should respond within 30 days.

This office shall charge a reasonable fee for our costs of copying and labor, postage (if any), and preparation if applicable.

Thanks for submitting!

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