Although Gastroenterology is closing, your medical records remain secure, and we are here to help you transfer records or continue your care.
In order to receive or transfer your medical records, please complete the medical records request form below in the hyperlink and return to FSA.
We are experiencing higher-than-normal request volume due to the transition, but we are working to complete requests as quickly as possible
How Requests May Be Received
- In person
- Fax
- Email*preferred gastromedicalrecords@flagstaffsurgical.com
- Patient portal *preferred
- New provider offices
Provide Authorization Form
Download Authorization To Release Records Gastro PDF
Must be filled out in full *No release without proper authorization unless otherwise legally permitted.
- Patient full name
- DOB
- Contact information
- Specific records requested
- Recipient information
- Signature/date
Approved Delivery Methods
- Secure fax to provider office *preferred
- Secure email *preferred
- Patient portal *preferred
- In-person pickup with ID