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Patient Name 12911 120th Ave. NE Suite C 50 Kirkland WA 98034 Tel 425 899-3234 Fax 425 899-3235 www. Rundoctor. com Lawrence M. Maurer D. P. M. Peter M. Vincent D. P. M. Surgery of the Foot Ankle Foot Ankle Sports Medicine AUTHORIZATION TO RELEASE MEDICAL RECORDS From Washington Foot Ankle Sports Medicine To Name of Provider Complete Address City/State/Zip Release the following information Copies of all Medical Records in your possession X-rays or any other diagnostic imaging studies...

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