Chart Transfer

This is normally initiated by yourself or by your new family physician. Your existing physician reviews your chart and sends a summary of your history with your relevant investigations, labs and consults to your new physician.

You will be informed of the cost of your chart transfer once the request has been received. You will be asked to sign a Release Information Authorization Form and pay for this service BEFORE the request is processed. Go to Send a Request and Payment Options below.

Chart Transfer Fee:

Individual Simple Chart Transfer $50
Individual Complex Chart Transfer, starting at $75
Family Chart transfer $100

Please allow at least 1 week for your chart to be transferred.

Request a Chart transfer:

Name

First Name

Last Name

Email Address

Chart Transfer Request

Your new physician contact information

(name, phone and fax number)

Payment options:

e transfer to info@mymicropractice.ca
Mail a cheque payable to Lina Suazo Hidalgo M.D.
Bring exact cash to the clinic during Front Desk hours
Pay online below