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Transfer Medical Records Request

To transfer Medical Records, please choose an appropriate form below.  Forms can be printed or downloaded.  It is important that you sign and date this form.

Please fax this form to 844-326-3118 or mail to:

Good Night Medical
Medical Records Department
8999 Gemini Parkway Ste 220
Columbus, OH  43240


Click Button On Appropriate Form Below:

To request that your medical records be transferred FROM a physician, medical practice,
or another DME company TO Good Night Medical, click Below:


To request that your medical records be transferred FROM Good Night Medical TO a physician,
medical practice, or another DME company, click Below: