PLEASE NOTE THAT HARBISON PSYCHOLOGICAL SERVICES, LLC CLOSED EFFECTIVE OCTOBER 31, 2011.
The procedures for obtaining your medical records are described below:
Former clients of:
Stephanie B. Boyd, Ph.D.
Farida Rassiwala, M.D.
Lettice Glen-Montgomery, LISW
Summer Clark, LISW
Ann Mac Prevost, LPC
Mona Saylor, LISW
Stephanie Abdalla, LISW
Please mail a request for release of information to:
Harbison Psychological Services, LLC
P.O. Box 14052
Augusta, GA 30919
Releases of Information must include:
- Name and contact information of former client
- Name and contact information of the recipient of the records to include the physical address and the telephone and fax numbers
- Description of the records to be released (ex: office visit notes)
- The signature of the client or the signature of the adult guardian if the former client was a minor
- The expiration of the consent to release information
*PLEASE INCLUDE THE NAME OF YOUR PROVIDER(S) AND THE APPROXIMATE DATES OF SERVICE TO ASSIST WITH LOCATING YOUR RECORDS.
BALANCES ON ACCOUNTS MUST BE PAID PRIOR TO THE RELEASE OF RECORDS.
THERE IS A $25.00 CHARGE FOR RECORDS REQUEST PROCESSING. A CHECK FOR THE PAYMENT MUST BE RECEIVED AND CLEAR YOUR BANK BEFORE RECORDS ARE RELEASED.
PLEASE MAIL YOUR PAYMENT TO:
P.O. BOX 14052
AUGUSTA, GA 30919
PLEASE ALLOW THREE WEEKS FOR RECORDS TO BE RETRIEVED FROM STORAGE AND TRANSMITTED TO THE DESIGNATED RECIPIENT OF THE RECORDS.