Medical Records Request

Who can request records

• The patient (adult)
• A personal representative with legal authority, such as a health care surrogate or guardian, with documentation
• Another provider or third party you authorize in writing

How to request

1. Complete the records request / authorization form — request one at 561-363-5538 or rn@majesticaesthetic.com, or pick one up at the office
2. Include a copy of government-issued photo ID
3. Specify what you need — full chart, operative report, photos, or a date range — and the format (paper, secure electronic)
4. Submit via a secure link we send you, in person, or by mail to 5315 Lake Worth Rd, Greenacres, FL 33463

Please don’t email forms with health information to a regular inbox.

Timing

We respond within the timeframes required by federal and Florida law. We’ll tell you in writing if more time is needed and why.

Fees

Any fee is reasonable, cost-based, and disclosed before we fulfill the request, as permitted by law.

Clinical photos

Clinical photos taken for your medical record are part of your chart and can be requested like other records. Marketing photos are handled under your separate photo consent, which you can revoke for future use at any time.

Corrections & denials

If you believe something in your record is wrong, you can request an amendment in writing. If any part of a request is denied, we’ll explain why and how to request a review.

Contact

Records & privacy: our privacy officer · rn@majesticaesthetic.com · 561-363-5538. See also our Notice of Privacy Practices