755 Highland Oaks Drive, Ste 202, Winston-Salem, NC 27103
Records Transfer
You have the right by law to access and/or transfer your own health information. You can ask to see or obtain a copy of your medical record and other health information at our practice as well as any other medical office. You may transfer your medical records to or from Ascend Eye Center by using the following forms:
Transfer TO Ascend Eye Center
To authorize transfer of your medical records to Ascend Eye Center from another facility, please use this RELEASE (INBOUND) form. For your convenience, we have already pre-filled our facility information as recipient and the type of records to transfer. Please send your completed form to the office that currently has your records.
Transfer FROM Ascend Eye Center
To authorize transfer of your medical records from Ascend Eye Center to another facility, please use this RELEASE (OUTBOUND) form. For your convenience, we have already pre-filled our facility information as sender. Please send your completed form back to Ascend Eye Center, either by postal mail or electronically to scheduling@ascendeye.com or by fax to (336) 293-4758.
Other Transfers
For all other purposes, you may utilize RELEASE (BLANK) form.