Patient Form Requests

the surgical clinic medical release forms


The Surgical Clinic outsources our release of information process to HealthMark Group. To follow up on the status of your medical record request, you may contact HealthMark Group directly at 800-659-4035 or

HealthMark Group fulfills all patient requests for personal copies at no charge to the patient. A complimentary copy of your record will be made available through HealthMark Group’s website, First time users are required to register for an account before accessing the website.

You may also submit a request electronically to HealthMark Group by registering for an account at Once logged in, you may select Submit Request from the menu options and enter all required fields to submit an authorization to HealthMark Group directly. HealthMark Group will process your medical record request and provide notification via mail or email once complete. A complimentary copy of your record will be made available for you to download through HealthMark Group’s MedRelease 360 website.


The Surgical Clinic has partnered with HealthMark Group to ensure the accurate and timely completion of your FMLA and/or Disability forms.

A signed and completed authorization form is required from each patient.

Each form requested for completion will require a fee to be paid directly to HealthMark Group. HealthMark Group will complete the forms upon receipt of the requested forms and a valid authorization. The estimated turnaround time will be 24-72 hours. If an email is provided, you will receive a response directly from HealthMark Group notifying you of the prepayment invoice. After payment, the completed forms may be downloaded directly through HealthMark Group’s website, or provided directly to you through an agreed to delivery method (i.e. secure email, mail, etc.)

If you would like to inquire on the status of your forms or have any additional questions, please call 972-895-2138 or email

the surgical clinic disability patient request forms
patient form requests with healthmark

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