John Bordiuk, M.D.
Ginette LaFleur, ANP
Staci Montori, L.M.T.

65 Walnut Street, Suite 380
Wellesley Hills, MA 02481
781.239.9900 • fax (781) 239-9953

Patient Forms

Medical Release Form

Print this form to authorize the release of your medial records to our office.

Medical Record Release Form