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GEENENS PSYCHIATRY, PA
4901 W. 136TH ST. 
LEAWOOD, KANSAS 66224
Tel: 913-488-2012 Fax: 913-276-7274

AUTHORIZATION FOR RELEASE OF MEDICAL INFORMATION

Please click on the PDF button to fill out the Release of information (ROI). Please fill it out completely. Save it. Upload your saved ROI on the white Upload Button.

Your ROI will be submitted to Daniel Albert, Patient Care Administrator.
Please call our office with any questions.
Upload Completed ROI here

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Your request will be processed within 72 business hours.

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