You will need to complete the Authorization for Release of Medical Information form
in order to obtain your medical records.
Once you complete Records Release form, fax it to (937) 297-2203 or mail it to:
Digestive Specialists, Inc.
Attn: Medical Records
77 W. Eleanor Drive
Springboro, OH 45066
Please note that Record Requests can take up to 6 weeks to process
Click here for a printer friendly Records Request form
Return the completed form to:
Fax: (937)297-2203
Mail:
Digestive Specialists, Inc.
Attn: Medical Records
77 W. Eleanor Drive
Springboro, OH 45066
There may be a charge for your records. The Current Rates are:
Minimum retrieval fee of $15.00
$1.00 per page for the first 10 pages.
$0.50 per page for pages 11-50.
$0.20 per page for pages 51 and higher
Postage (if records are to mailed).
Summary fee (if a summary is requested).
Digestive Specialists, Inc.
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