![120223466-request-for-radiology-records-form-middletown-medical](https://cdn.cocodoc.com/cocodoc-form/png/120223466--Request-for-Radiology-Records-Form-Middletown-Medical--x-01.png)
Request for Radiology Records Form - Middletown Medical
Request for copies of xrays, ct scans, mris and sonograms patient must give a 48 hour notice on request for xray films. patients may be responsible for a 3.00 charge per film. todays date: patient name: d.o.b.: phone # : ( so we may call when...
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