CONTACT US

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To request the release of Protected Health Information (medical records), complete the consent form provided below. To avoid processing delays, ensure all applicable sections are completed.

Submit completed forms to:

service@premierosm.com

Please allow up to 30 days for processing. Fees may apply.

(Pursuant to Ala. Code § 12-21-6.1)

Search fee: $5.00

First 25 pages: $1.00 per page

Pages 26 and beyond: $0.50 per page

Mailing: Actual cost

CD DICOM Images: $10.00 per CD

Special records: Actual cost of reproduction

*Applicable fees will be invoiced. Requests are processed upon receipt of payment.