Atlanta Riverdale | Medical Release

||Atlanta Riverdale | Medical Release
Atlanta Riverdale | Medical Release 2018-01-26T13:49:06+00:00
  • Medical Release Authorization

    You are authorized and directed to furnish any and all information requested pertaining to my medical care and treatment to:

    Dominion Orthopaedic Clinic, LLC
    John I. Foster, III, M.D., FACS
    William G. Sutlive, III, M.D.
    Nicole E. Forsythe, M.D.

    5555 Peachtree Dunwoody Road
    Suite 215
    Atlanta, GA 30342
    Phone: (770)455-4009
    Fax: (770)455-4065

    This authorization includes furnishing of the originals or copies of all charts, summaries, test results and all other written memoranda or data including x-rays and photographs.