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Mountainous Landscape by the Sea
Consultation
Intake
Client's Date of Birth
Month
Day
Year
Relationship of Requestor to the Client
Self (they are my records)
Power of Attorney
Executor (for deceased clients)
Other
Type of records being requested (check all that apply)

Medical Records Request

Past and current clients of Terra Soma Health and previous clients of Outdoor Therapeutics may use the following form to initiate a medical records request. Please be aware that a release of records may take up to 21 days for delivery and administrative fees may apply. You will be contacted about next steps within 3 business days of your submission. If you have questions before submitting a formal request, please contact info@terrasomahealth.com. 

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