Records Release Form
Medical records can only be release to medical provider.
Please download fillable PDF document, fill-out, and either mail to the address at the bottom of the page or email to Office@jayclinic.com.
There is a $10.00 non-refundable processing charge.
Please mail a check to:

The Jay Clinic
3257 Suite One 19th St NW
Rochester, MN • 55901
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