Medical Records:

If you are leaving our practice we need you to fill out a Medical Records Exit Interview so we can improve our customer service. All information provided is confidential. Additionally, you will need to fill out a Medical Records Release form so that we may release your records to you or your new provider.

If you would like us to share your medical information with family members or non-medical facilities, please complete our Authorization Form.

If you have a problems downloading any of these forms try this:

  • PC users:
    With your mouse right click on the link above and choose “Save Target As”.
    Choose the destination for your download and click "OK" or "Save".
  • Mac users:
    With your mouse hold the mouse button down and choose “Save Target As”.
    Choose the destination for your download and click "OK" or "Save"

 
© Copyright 2005, Herndon Family Medicine, Inc. 555 Herndon Parkway Suite100, Herndon, VA 20170 All Rights Reserved.