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.


By Pima Dermatology | © 2024 All Rights Reserved. Design & Development by Goldman Marketing Group | Sitemap | The information available on this web site is provided for informational purposes only. This information is not intended to replace a medical consultation where a physician's judgment may advise you about specific disorders, conditions and or treatment options. We hope the information will be useful for you to become more educated about your health care decisions.