Request Medical Records Please allow 4-5 business days for your request to be processed. We will be contacting you to confirm the request.Select Location*- Select -CovinaWest CovinaEl MonteLa PuenteSelect Physician*- Select -Michael Bang, M.D. Family PracticeBishoy Samuel, M.D. General PracticeVirgencita Cortez, M.D. Internal MedicineDavid Martin, M.D. Internal MedicineCharlotte Capulong, N.P. Nurse PractitionerMelinda Rodriguez, N.P. Nurse PractitionerCarlos Cervera, PA-C Physician AssistantSelect Physician*- Select -Bishoy Samuel, M.D. General PracticeLina Dela Cruz, M.D. Internal MedicineCesar Jimenez, M.D. Internal MedicineSuneetha Ali, M.D., FACOG GynecologistLara Clark, PA Physician AssistantHelen Taylor, PA-C Physician AssistantSelect Physician*- Select -Rekha Sachdeva, M.D. PediatricianSelect Physician*- Select -Jesus Arenas, M.D. Family PracticeDate of Service* Date Format: MM slash DD slash YYYY Name* First Last Date of Birth* Date Format: MM slash DD slash YYYY Phone*Email Where should the records be sent?Pickup At LocationFaxFax Number*PhoneThis field is for validation purposes and should be left unchanged.