When ever a patient or doctor needs personal copies of lab results, medical records, letters of necessity or even a Super Bill for insurance submissions we’ll provide them for you.
Below, find our Wellness Architecture request form(s), follow the instructions provided and you’ll soon have your medical records in hand or to your requested destination.
Medical Records Requests
Medical records will be released to another provider only after receipt of a request in writing, signed by the patient (or his/her legal guardian). Please download and complete this form. Fill out the form(s) as completely as possible and include the name and address the records should be released to.
Letter, Referral, Doctor notes & Super Bill Requests
If this is concerning a Letter of Necessity, Referrals, doctor notes or a Super Bill please contact our office via email and specify exactly for what purpose you need it for so we can provide the right document the first time. Please download and complete this form if you haven’t already. Be as specific about the information you’d like released.
Email, fax or USPS mail your request to:
Wellness Architecture Naturopathic Medicine
Release of Information
841 El Camino Real
Menlo Park, CA 94025
While the law allows us up to 30 days to complete your medical-records, letters and super bill requests, we can often complete the request in 1-2 weeks from the time handling charges are received (if applicable). This is not guaranteed until we’ve discussed your request with you, so for planning purposes, do allow up to 30 days for fulfillment of your request.
Referral letters or doctor note’s typically take 5-14 business days unless stated otherwise by our office.
***No same-day or immediate processing of medical records, letters, super bills, referrals or doctors notes.
We are happy to send results of tests Dr. Samia McCully has ordered on your behalf, to another healthcare provider (or to you) for a small handling fee depending on the form of delivery. To avoid charging you for releasing the same records again in the future, we prefer to send the digital file directly to you, so that you will then have permanent direct access, and can provide copies to whomever you choose.
Letters of Necessity for supplementation, test, etc a fee may be applied depending on the length of time needed to drafting/completing a customized letter based off your medical chart and treatment plan.
Costs for all Medical Chart files are as follows. All of these are well below the level provided by law.
- Faxing: digital medical records, lab results are free of charge. If your are requesting a medical chart as a previous patient that has not been seen by Dr. McCully for over 12 months there is a handling fee of $10. No exceptions. You are required to fill out a Medical Record Release Form for the doctor or person in question receiving them.
- USPS Mail: for actual postage fee (via US Priority Mail) and 0.50 per 1-25 pages and 0.25 per 26-up pages. If your are requesting a medical chart as a previous patient that has not been seen by Dr. McCully for over 12 months there is a handling fee of $10 in addition to the previous stated page rates. You are required to fill out a Medical Record Release Form for the doctor or person in question receiving them. Multiple destinations incur multiple handling fees. No exceptions.
- In Appointment: Copies for any test is free if asked for during the appointment in which we are discussing it or request via online after filling out a Medical Record Release Form for yourself.
Your request will be fulfilled within 30 days of the original request, after receiving payment (by Cash, Check, Mastercard, Visa, Discover, American Express and most Debit cards prior to sending the records). Once you’ve contacted us with your request, we will review your chart, advise you of the cost (if any), and send you a invoice request.
Please contact us further if you have any additional questions.