We appreciate the opportunity you’ve given our doctors to serve your healthcare needs. You have a choice when it comes to podiatric care and we are glad you have chosen Ankle and Foot Center of Tampa Bay for your foot and ankle needs. We also know that with your choice you’re saying that you trust our doctors to provide the highest level of service possible for yourself, your children, and your loved ones. We do not take that trust lightly. We work hard each and every day to ensure that you made the right decision.

Download Privacy Practices (HIPAA) Form

Download Non-Discrimination Form

  • To authorize a copy of your medical records to be sent or released to another medical facility, to an outside entity or to obtain a copy for personal use, please click on the following Authorization below to download a form:

Download Authorization

  • To authorize Ankle + Foot Center of Tampa Bay to receive a copy of your medical records from another medical facility or outside entity, please click on the following Authorization below to download a form:

Download Authorization

  • Please return all forms to the Medical Records Department:

Via Fax:
813-428-8448

Via Email:
tampamedrecords@extremityhc.com

Via Mail:
Extremity Healthcare
Medical Records Dept.
900 Circle 75 Pkwy
Ste. 900
Atlanta GA, 30339

* Please note, there is no charge for medical records to be sent to another healthcare facility. If records are being obtained for personal reasons, you will be charged a minimal fee per page. For digital X-rays additional fees will apply. The fees can be paid by check via mail or you can pay via credit card by contacting the Medical Records Department at 813-675-9718.

Thank You

Medical Records Department