Medical Records Requests

Equinox maintains records both for Equinox Primary Care as well as for Qliance.  If you are an Equinox member or a former Qliance member, please use the forms below.  Per federal law, we must have a form with a wet signature (no stamped or electronic signatures), so you will need to print, sign, and then either fax or scan and email to us.  If you would like your records emailed (and they aren't too big of a file), make sure to complete the email consent form.


Click for forms:

We will respond to your fully completed request as quickly as possible, but expect it to take up to two weeks.  If you need your records sooner than that, please make sure to let us know.