Heading 2Request for Medical Records Transfer My Family Health Medical Centre - Willowdale Shop 9, Willowdale Shopping Centre, Willowdale Dr East Leppington NSW 2179 Ph: (02) 8305 3050 Fax: (02) 8305 3051 Secure Email: admin@myfamilyhealthmc.com.au 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.
