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Records Release Form

This form is available for your use; however this is not a required form. It is important that the Authorization to Release Records form is completed in its entirety. It should include as much detailed information as possible about what records are being sent or requested.

The form may be completed online, then printed and faxed or mailed to us at

     ENT Associates of Greater Kansas City, PA
     216 NW Executive Way
     Lee’s Summit, MO 64063

     Fax: 816-875-2597
We require at least 2 business days to prepare and send requested records.

Please feel free to contact the Medical Records Department at 816-875-2595 if you have any questions.