125 Inverness Dr E, Suite 210
Englewood, CO 80112


Medical Record Release Forms

Please click on link below to enter information.  If you are requesting records FROM Center for Women's Health you may email or fax completed forms to us.  Please allow 48 hours to process your request. 

If you are requesting records be sent TO Center for Women's health from another provider or facility you may use our form but the form should be sent to the providers office that has the records. 

Use the File/Save As option to save the form to your computer.   If you exit the form before saving to your computer your information will not be saved.  

Medical Record Release Form

Email - Send completed forms as an attachment to Forms@tc4w.com

Fax - Fax forms to 303-500-3387

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Our Providers

Asela C. Russell, MD
Leslie T. Scariano, MD
Grace M. Holub, MD
Heather Fitzler, MD

Phone: 303-755-0120
Fax: 720-708-6269
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Center for Women:
Center for Wellness MD

Parker Adventist Hospital
Skyridge Medical Center
Castle Rock Adventist Hospital

American Heart Association
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