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Filling Out a Medical Form

Medical Records Release

6560 Fannin St. Suite 1812
Houston, TX 77030

Phone

832-306-3209

I authorize the disclosure of my protected health information Required
I authorize Texas Retina Center to release my protected health information: Required
Thank you for submitting!

Scurlock Tower

6560 Fannin St. Suite 1812
Houston, TX 77030

Phone: 832-306-3209

Fax: 832-356-5462

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