Heading 2Request for Medical Records Transfer My Family Health Medical Centre 2/3 Rodeo Rd, GREGORY HILLS, N.S.W., 2557 Ph: Fax: Secure Email: Date: Dear Dr : Patient full name (print) Address DOB Other family members (if under 18 years of age) Address DOB The above mentioned now attends this practice. To assist in their future medical management. Would you kindly forward: (tick option) Please do not send
