Medical Records Release

You have two options to request and authorize release of your medical records.

1.  Using the Authorize Release of Medical Records option on our Patient Portal.   This online option allows you to electronically sign and submit your authorization through our secure messaging system.

2.  Complete our Medical Records Release Form, sign, and either fax to
317-842-4393 or mail to:

Midwest Ear Institute, P.C.
Attention: Medical Records
7440 N. Shadeland Avenue, Suite 150
Indianapolis, IN  46250

The forms are in Adobe Acrobat (PDF) format.  If you do not have Adobe Acrobat Reader, click on the icon below to get a free version.


If you have any problem getting the forms to print properly, please call our office at 317-842-4901 or 800-818-EARS (3277) and we will gladly mail or fax them to you.