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To request a copy of your medical records, please complete the electronic form below. Once completed, the form will be automatically emailed to our Medical Records Department for processing.You can also download the form here. Completed forms may be emailed to firstname.lastname@example.org, faxed to 833-734-1183, or mailed to: Alliance Physical Therapy Group Medical Records Coordinator 607 Dewey Ave NW, Ste 300 Grand Rapids, MI 49504 Forms may also be faxed to 833-734-1183 attention Medical Records Department.