Medical Records Request Form

Fill out this form if you would like
MAPA to send your records to an outside party.

Medical Records Request

*Email completed form to medicalrecords@mountainareapeds.com

Medical Records Release Form

Fill out this form if you would like
your medical records sent to MAPA.

Medical Records Request

*Email completed form to medicalrecords@mountainareapeds.com

Medical Records

Medical records can be picked up in person, faxed or sent via encrypted e-mail. In order to process your request, please complete the appropriate Medical Records form above and email to Medical Records.

School &  Sports Forms

We require 3-5 days processing for ALL FORMS.

If you need daycare, school forms or sports forms: first COMPLETE THE PARENT PORTION of the form and then email to Clinical Team.

Immunization Records or Kindergarten Forms

If you only need an immunization record or kindergarten form, please submit the information in the box to the right and notate “Immunization Record or Kindergarten Form” in the message section.

Please allow 3-5 days for processing for any and all requests. If we have not gotten back to your request within 3 business days please call us directly at 828-254-4337 or email us at medicalrecords@mountainareapeds.com.

IMPORTANT! If you do not see a success message after submitting, one or more of your answers are either not valid or blank on a required field. Please review the fields highlighted in red and re-submit.

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