Medical Record Request

This medical record release applies only to patients seen by Dr. Chang in her private practice prior to March 1, 2022, or after October 25, 2025.

For records pertaining to visits between March 1, 2022, and October 25, 2025, please contact the office where you were seen during that time.

Please download and complete the form. Email back to info@icarewomen.com or fax to 626.210.2626

For patient seen prior to March 1, 2022, or after October 25, 2025, please send the medical request form

to info@icarewomen.com or fax to 626.210.2626

此申請表僅適用於曾於 2022 年 3 月 1 日之前或 2025 年 10 月 25 日之後，在張醫師私人診所就診的病患。

若您是在 2022 年 3 月 1 日至 2025 年 10 月 25 日之間就診，請聯絡您當時就診的診所以申請病歷資料。

請下載並填寫此表格。完成後，您可以透過電子郵件寄至 info@icarewomen.com，或傳真至 626-210-2626。