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Pediatric Associates of Western Connecticut, LLC fax number

(203) 792-6510

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

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.

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