UPDATE – May, 2022
After more than 30 years of service to the greater Baltimore community, The Neuroscience Team is suspending activity at this time (June, 2022), due to need to downsize our operations for health reasons. Dr. and Mrs. Newman will be continuing their work at Psychological Evaluation & Therapy (443-761-5000), and we welcome you to make contact through this company, should you wish to pursue excellence in treatment. For those requesting records to be released, please complete the form as indicated below. Thank you for your patronage and support through the years, and may God bless you and yours with good health.
With Blessings,
Gabriel & Tamar Newman
Medical Record Requests:
To request medical records: please print the form below, and fill out. Then fax to: 877-977-0511
Name:__________________________________Patient for whom record is requested:_______________________
Please specify the records requested. We do not advise release of progress notes of sessions in unrestricted form, since this compromises and cancels patient confidentiality. Instead, please specify the specific reports requested, and perhaps a summary of treatment.
Records requested:_________________________________________________________________________________
__________________________________________________________________________________________________
Specify form in which you wish to receive the records (email, fax, or mail):__________________________________
Your address:______________________________________________________________________________________
__________________________________________________________________________________________________
Phone number: __________________________ Fax number (if available):____________________________________
Email address:______________________________________________________________________________________
Please sign below: I hereby verify that I am legally authorized to receive medical records on behalf of the above-named patient, and that I will protect the confidential and HIPPA-protected nature of these records.
Signed: ____________________________________Print your name:____________________________