Forms

Here are our most commonly used forms. New Patients, please notice that you can either download the forms you will need for your first visit individually or bundled. Forms (Camp, School, FMLA, Disability, etc) will generally be completed by the physician or PA in 5-7 days. If form needs to be expedited, there is a $50.00 fee, payable at the time of the request.

Please choose from the following:

To make our process quicker and easier, Lake Street Family Physicians outsources our requests for Medical Records to HealthMark Group. HealthMark Group fulfills all patient requests for personal copies at no charge to the patient. Your record will be sent to you electronically or in paper form.

To Request a Copy of your Medical Records:

Register for an account at https://requestmanager.healthmark-group.com/register
Once logged in, select “Submit Request” from the menu options and enter all required fields. This will provide authorization to HealthMark.
Your medical record request will be processed and a notification will be sent via mail or email once complete and available for download.

If you have any questions, please log in to Request Manager for status updates or to chat with support. You may also contact HealthMark at 800-659-4035 or email status@healthmark-group.com.