Medical Release Form for Dr. Jeck’s Patients

A Warm Welcome to Dr. Tracy Jeck’s Patients

Please download, print, and complete the Authorization to Release Medical Records & Information Form HERE.

To enable Tracy Jeck, MD to obtain your medical records, please download the Medical Records Release Authorization form so she can request them on your behalf.

  • Once completed and signed, you can mail in the authorization to Pima Dermatology or fax the document to (520) 795-4177.
  • Until August 31st, you may also call her existing office at (520) 615-3444 to request your records.
  • After that date, records will be maintained by Ironwood Dermatology. You may request them by calling (520) 618-1630.

 

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