NEW PATIENT FORM

Patient Release Form

Please fill out the form below to have your child's medical records released FROM Children's Medical Group to a new provider. Alternatively, you may download the form below and bring it to our office.​ Please allow 5-7 days for requested records to be sent.

Download PDF

Select Office Location

Please select your current provider's office location below:

Airport office:

3920 Airport Blvd
Mobile, AL 36608

Select Office

Providence office:

610 Providence Park Dr.
Mobile, AL 36695

Select Office
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