Medical Records Request

Request An Appointment


    Proliance Surgeons/OPA values your business and respects your rights to privacy. Each employee and service provider has signed a confidentiality agreement. You will be asked to give private information including name, address, date of birth and social security number. We will verify insurance information at each visit. Many insurance companies are moving away from using your social security number on your cards to be safer. However, you should be aware that information is still required on our billings and will be requested. We can not serve you if you do not provide this information. In addition Proliance/OPA follows all current HIPAA regulations to assure that your private medical information remains confidential.


    We retain your electronic medical records for a 10-year.  We make every effort to have your previous records available for your visit. If you are seen on an emergent basis, your previous medical record will be combined with your current record after the visit.


    You or your representatives may request records. Your medical records will only be released with your written approval. This requires a form to be filled out with a current signature and date indicated. Please note there may be fees associated with these requests.

    To request your medical records please fax your completed Medical Records Request Form
    to 206-622-1644.

    If you have any questions please call our team at 206-694-6630.