Records Request Form

You have a right to request access to review and to receive copies of your protected health information.  Please see ASSOCIATED RETINAL CONSULTANTS, P.C. (“ARC”) Notice of Privacy Practices or contact ARC’s Privacy Official for information.

Click on the following link to download request form:  Request For Access to Health Information

The completed and signed form may be sent to our Records Department by e-mail, fax, or U.S. Postal Mail:

E-mail:  [email protected]

Fax:  248-319-0169

Mail:  Associated Retinal Consultants, P.C., 2000 North Huron River Drive, Suite 100, Ypsilanti, MI, 48197