In order to obtain your health information from other facilities you must complete the CONSENT FOR RELEASE OF MEDICAL INFORMATION form.

Please complete and mail form to:

Park Cardiothoracic & Vascular Institute
575 Coal Valley Road, Suite 504
Jefferson Borough, PA 15025

Or fax completed form to:

Park Cardiothoracic & Vascular Institute
412-469-7919

If you have any questions, please contact our office staff at 412-469-7900.