Patient Resources and Forms

Patient Resources and Forms

If you are established patient and wish to schedule a follow up appointment, please contact our scheduling staff via our patient portal or phone our office.

Patient Forms

  1. Please complete this form to request that records be sent from another healthcare provider to our office.  You may complete the form online and we will fax this to your provider or you may download the form and complete it by hand, and then fax or mail this to the office of your provider.
  2. To request that records be sent specifically for participation in research studies, please complete the following medical records release form for CenExel RMCR.

We are very careful with your medications. Because of this, we require that you bring with you, to every appointment, a completed Medication List.

If you are an established patient, please download, print, and complete by hand a medication list of your updated medications the day before your appointment. Please bring this document to your appointment.

By signing this telemedicine consent form, you acknowledge that you understand and agree to participate in medical consultations and treatments via telecommunication technology. You recognize that while telemedicine offers convenience, it may have limitations compared to in-person visits. Rest assured, your privacy and confidentiality will be upheld to the highest standards. Thank you for embracing innovative healthcare solutions to ensure your well-being.

By providing your consent to receive email communications, you agree to stay informed about important updates, appointments, and relevant healthcare information. Your privacy and security are our top priorities, and your information will only be used for necessary communication purposes. Thank you for helping us streamline our services and enhance your healthcare experience.

Send secure electronic communications and medical records to us for consideration of treatment or to request Huntington’s disease genetic testing appointments via the upload form. To submit documents or medical records regarding participation in clinical research trials, please upload documents using a dedicated CenExel RMCR form.