Medical Release Form

Request Form

BG NEUROLOGY

(DBA: Carolina Neurology)

Spartanburg office: 1770 Skylyn Dr., Spartanburg, SC, 29307

Easley office: 403-A Hillcrest Dr., Easley, SC 29640

P: 864-577-9107 F: 864-699-1999

I hereby authorize the release of my medical records or copies of such records…

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