WebTo reach our Patient Experience Team, complete the items below. We look forward to connecting with you! Fields marked with an asterisk * are required. Patient First Name * Patient Last Name * Patient Date of Birth * What is the best way to contact you? * Reason for Inquiry * Medical Group * Care Location/Town * Care Provider Name * WebCall Us First; Primary care; Specialty care and diagnostic services; Clinical outreach programs; View all services and programs

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WebCity, State, Zip: Phone Number: Proxy Information (all fields are required) Proxy Name: Date Of Birth: Address: Email Address: City, State, Zip: Phone Number: Relationship to Patient: Electronic Protected Health Information in ProHealth Care’s MyChart Secured Messaging Appointments Test Results Medications WebAddress: Phone #: City: State: Zip Code: Fax #: Purpose of Request: Personal Treatment Legal Insurance Disability ... apply to the patient’s medical records. Check one Initial each line below ... St. Francis Care, Burgdorf / Fleet Health Center, 131 Coventry Street, Hartford, CT 06112 to release my health information as noted below: make csv from excel

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Web5 reviews of ProHEALTH Lake Success Medical "Dr Joanne Lee is my internal medicine MD I am a medical professional and I recognize … WebFax Numbers To find a fax number: Search for the specific office you need to contact. Click the link to the office's web page Offices with a fax will list the number in the Contact Information panel of their office page. Bronson MyChart (269) 341-7723 or (800) 451-6310 Monday - Friday, 8 a.m. - 5 p.m. EST [email protected] WebRecords requested through NorthShoreConnect can only be released back to the patient. Email/Fax Email: [email protected] Continuation of Care Requests: … make css responsive