GhearingMD

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MEDICAL RECORDS RELEASE FORM

931-243-5259

These contacts will be available until May 31, 2019, when the practice will officially close:


PHONE     931-243-5259 
FAX            931-243-5156 
EMAIL       GhearingMD@gmail.com

Please be sure to sign, witness, and date the release for medical records before submitting it with your payment. Cost of medical records, in accordance with Tennessee Code Annotated 63-2-102, is $20.00 for the first 5 pages, .50 for each page after the 5th page, and may include the actual cost of mailing. 


You may bring it to the office before May 31 or mail it to Dr. Ghearing, P.O. Box 158, Celina, TN 38551.


Thank you.


NOTICE:
The medical practice of 
Gilbert Ghearing, M.D.,  in Celina, Tennessee, 

will be closing due to health reasons

and subsequent retirement.



To request your medical records,

please download the form below.



The mailing address is
P.O. Box 158, Celina, TN 38551.