Medical Records Request
Purath Headache & Neurology is responsible for managing your medical information, including medical records requests, for care provided at Purath Headache & Neurology (Greenfield, WI). In compliance with state and federal regulations, all medical record requests must be submitted in writing.
How to Request Your Records
To request a copy of your medical records, please complete the appropriate Authorization for Release of Health Information form below and deliver it in person, mail or fax.
Download Instructions for Completing (PDF)
- Complete the form, in its entirety, following the instructions above.
- Sign the form and submit it via one of the methods below. All sections must be complete, and the form must be signed by the patient, or the patient’s legal guardian/legal representative.
Send your request to:
Purath Headache & Neurology
Attention: Medical Records
7701 W Barnard Ave
Greenfield, WI 53220
Forms may also be dropped off in person, Monday through Friday, during regular business hours or faxed to (414)837-5688.
Please allow 7 to 14 days for processing.