These forms can be faxed to 972-733-6564, mailed or dropped off at our office.
- To send or transfer your records to/from another provider such as a previous primary care physician, specialists, and mental health providers – choose one of the following
- Medical Records to be Printed form to print medical records for your own files. Please note, a fee will be charged and must be paid prior to receipt of the printed medical records.
- Referral Request Form to request a referral (including medical records) for a specialist or mental health professional.
©2019 Girls to Women Health & Wellness
16980 Dallas Pkwy 75248 Dallas, United States P: (972) 733-6565
4200 S. Hulen Street, Suite 450, Fort Worth, Texas 76109 P: (817) 524-1811
Fax: (972) 733-6564
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