Medical Records Release Form Request and Release of Medical Records To Whom it May Concern Please release the medical records of the following patient to St Lawrence Optometry via fax to 613-549-4510 or email to info@slvision.ca - Patient Name: First Last DOB: MM slash DD slash YYYY Health Card #:Previous Optometrist/Ophthalmologist: First Last Phone:Fax:Email: Signature: Δ
Please call our clinic to confirm operating hours as they are subject to change without notice.