Marietta Eye Clinic :: Medical Records

Medical History Form

Medical Records/Health Care Information

Obtaining a copy of your Marietta Eye Clinic Medical Record is easy. To start your request, simply download, print, complete and sign the following forms and fax or mail them back to us using the contact information at the top of the form.  You may also send it via email to 9_Medical_Records@mariettaeye.com. Please send to attention "Release of Information, (Medical Records)." Before sending, make sure you have completed and signed the form. Unsigned and incomplete requests cannot be processed.  

Your request will be processed and fulfilled within 30 working days. We will either mail your copy to the address specified on the following authorization form, or you may pick up your copy from our offices located at the address above between 8 a.m. and 4:30 p.m., Monday through Friday.

Copies are $0.97 cents per page. We will send you an invoice by mail to let you know how much the total charge will be once we retrieve your records.  You may pay by debit/credit card or send a check by mail or in person should you wish to retrieve your records personally.

Should you wish to contact the Clinical Information Department (Medical Records), you may call 770-427-8111 ext. 2016 or email us at: 9_Medical_Records@mariettaeye.com.

Medical Records Release Form

A summary of your visits during 2016 and beyond will be accessible via the patient portal.  Please see below for information regarding enrollment in the portal.