Record requests must be completed and sent to Quietly Radiant.
This is a HIPAA requirement to prevent release of personal information.
Please print this form, complete, and mail or fax (757-690-0285) to request your records be sent to your new provider's practice.
If you are requesting records to be sent to your home address, please be sure to mail your request with a pre-paid self-addressed and stamped 9x12in manila envelope. We suggest paying postage for priority mailing, approximate cost being $7.35.