HOOSIER HOUSECALLS, PC
John D. Riley, MD                                                                                                 Theresa C. Treep, MD


TO REQUEST MEDICAL RECORDS FROM

HOOSIER HOUSECALLS TO BE SENT TO A NEW PHYSICIAN,

PLEASE FAX A
SIGNED RECORDS REQUEST FORM

FROM THE REQUESTING (NEW DOCTOR’S) OFFICE TO:

(317) 776-9219

OR MAIL REQUEST TO:

PO BOX 6328
FISHERS, IN 46038-6328


PLEASE ALLOW 2 WEEKS FOR PROCESSING.

THANK YOU.
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