Pediatric Associates of Lawrenceville

Please complete and submit the following form and one of PAL's office staff will process your request as soon as possible.

Fields marked with an asterisk (*) are optional. All other fields are required.

Make a Medical Records Request from PAL

Parent’s full name
Child’s full name
Child's date of birth
Contact telephone number
Alternate telephone number*
Contact e-mail address
Contact preference	Respond by telephone Respond by e-mail
Recipient's name
Recipient's address
Recipient's city / state / zip
Reason for request

Request Process
Please allow our staff 1 to 3 business days to respond to your online inquiry. If you experience difficulty completing this form, or would rather contact PAL by telephone, please call 770.277.6725.
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