Patient Rights, Medical Records Requests & Consumer Complaints

Patients may request copies of their medical records by contacting our office:

Dynamic Spine and Performance
Phone: ____________________
Email: ____________________
Fax: ____________________
Address: _______________________________

Please include:

• Patient full name
• Date of birth
• Contact information
• Description of requested records
• Signed authorization if required

A valid photo ID may be required before records are released.