Board Certified Orthopedic Surgeon

Opening Hours : 9 - 5 weekdays |
  Contact : 310.574.0487

Request Your Medical Records

Jesse

Medical records requests

Direct tel: 310.574.0487

Email Jess your Medical Records request

By US Mail or FAX:

To request a copy of your medical records with our paper form, please use this link, then print and complete our medical records release form.

Print out the Medical Records Request Form below and then return the completed form to me.
Return by Fax
Fax it back to 310.574.0485

 

Return by Mail
DISC Sports & Spine Center
attn:  Dr. Fredric Nicola
13160 Mindanao Way, Suite 300
Marina del Rey, CA 90292

Please allow 5-7 business days to accommodate your request.

Medical Records Request Form

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Fill out the form for any questions

 

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