top of page

UNIQUE_LOGO-removebg-preview_edited_edit

Home
Payment Plans
Our Team
Insurances
Book Appointment
Gallery
About us
Contact
Request Medical Records
More

Use tab to navigate through the menu items.

Request Medical Records

Authorization for Realease of Medical Information

Please take a moment to fill out the form.

Patients Information

Patient's First Name

Patient's Last Name

Patient's Date of Birth

Patient's Phone Number

Email

Person Requesting Records if Different than Patient

First Name

Last Name

Phone Number

Email

Thanks for submitting!

Unique HealthCare & Wellness

SERVICES

CENTER

INSURANCES

CONTACT US

9963 SW 142nd AVE Miami, FL 33186

Medical Exam
Laboratory
Aesthetic- Botox/Fillers
Plasma Treatment
Weight Loss
EKG
Mental Health Services

9963 SW 142nd Ave
Miami, FL 33186

Care Plus
Doctors
Oscar
Cigna
Aetna
Medicare
Memorial Health Network
VA Community Care Network

Telf: 786.360.5558

Fax: 786.334.5486

Email: info@uniquehcw.com

Follow Us

© Unique HealthCare & Wellness

bottom of page