Please click on the link above to download, fill out and return to Strathmoor Pediatrics. We cannot provide any records unless we receive a properly completed form. The form MUST be signed by the custodial parent or guardian on record. If the custodial parent or guardian has changed, that information must be provided prior to any records being sent. There MUST be a separate request for EACH child. Please indicate if you want them faxed, emailed. Alternatively we can print the records to disc and mail for a $5 fee.
Please direct any specific questions to Tonya – firstname.lastname@example.org.
Dwayne Johnson, M.D.