Medical Records

To request a copy of your medical records, please complete the electronic form below. Once completed, the form will be automatically emailed to our Medical Records Department for processing.

You can also download the form here. Completed forms may be emailed to [email protected], faxed to 833-734-1183, or mailed to:


Alliance Physical Therapy Group
Medical Records Coordinator
607 Dewey Ave NW, Ste 300
Grand Rapids, MI 49504

Forms may also be faxed to 833-734-1183 attention Medical Records Department.