To request records, contact the office and say whether the copies are for you or another provider. Have your name, date of birth, and the dates of care ready. The office will tell you which form to use.
Download the medical records authorization form from this page. Use the current form, not an old copy. If the file does not open, call 407-616-1691 and ask for it to be sent to you.
Fill in every required field, including who should receive the records and which dates of care to include. Sign and date the form. An unsigned form cannot be processed.
Include a clear copy of a photo ID with the signed form. The name on the ID should match the request. This step helps protect your health information from the wrong release.
Send the signed form and photo ID by the method listed on the form. Keep a copy for your records. An incomplete packet is returned so the missing item can be added.
If you have not heard back, call 407-616-1691 and ask about your records request. Have your name and date of birth ready. Do not use this number for a medical emergency.
After a complete request arrives, the office reviews the authorization and the photo ID. If something is missing, you are contacted before any records are released. Turnaround depends on the request. Confirm timing with the office before you rely on a date. Psychotherapy notes, if any, may need a separate authorization. You will be told if that applies.
Fees may apply depending on the type and format of records requested. If a fee applies, the office gives the amount and payment instructions before payment is required. For the current figure, call 407-616-1691. No dollar amount is printed on this page.
Pay only after the office sends the amount and instructions. Do not send payment with the form unless asked. Ask for a receipt when you pay.
Records are released only with a valid authorization, except where the law allows a disclosure. A photo ID and a complete form help prevent release to the wrong person. Read the Notice of Privacy Practices for how health information may be used. Questions can go to 407-616-1691 or info@starmarisadvancedpsychiatry.com.
Download, complete, and sign the authorization form below. Add a photo ID, then send the full packet to the office.
Getting started with StarMaris is simple. Please complete the forms below before your first appointment to help us provide timely, personalized psychiatric care. Referring providers can submit patient referrals securely online. For questions, call us at 407-616-1691.