Release of Medical Information - FROM Dr. Wagner

If you want Dr. Wagner to release your medical records to another provider, click below to print the release form...

 

In order to expedite your request, please provide All information requested and sign and date.  
Return your completed form to us and we will release your records per your instructions.
 

Copyright © 2020 Laura Wagner, MD. All Rights Reserved.
14377 Woodlake Dr. #111 • Chesterfield, MO 63017
314-434-1111