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