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Pediatric Associates of Western Connecticut, LLC fax number
(203) 792-6510
Wrong or outdated? Report this number
Pediatrics
Used for: Medical records release and records requests
Fax destination details
- Department
- Pediatrics
- Purpose
- Medical records release and records requests
- Form
- Release of Records Authorization — Release of Records Authorization
- Address
- 41 Germantown Road, Danbury, CT 06810-4087
- Voice phone
- 203-744-1680
- Website
- Visit organization website
Before you send
- Confirm that this exact department handles your document or request.
- Check the organization website or call its main line for the current fax number.
- Include a cover sheet and any case, member, claim, or form reference required.
- Keep the delivery confirmation with your submission records.
Fill in patient information, recipient/organization receiving the records, scope of records to be released, dates (if applicable), and your signature. Fax the completed form to the office to authorize release of medical records.
Official form instructions are published as a downloadable file on the organization's website.
Sources and verification
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