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FAX 770-489-8318

We’re inside the Douglasville Sam’s Club Optical at 6995 Concourse Pkwy, Georgia.


Vision gives us the
power to dream big!

Vision gives us the
power to dream big!

Home ยป Records Request Information Form

Records Request Information Form

This records request form is to send your records by E-mail or receive information on how to obtain the records by other means. The person filling out this form assumes responsibility for the information to be factual and used for non-malicious intent.

  • **If the patient had a name change, please list the name used at the time of the exam.
    Full records may take up to 30 days to send, and records beyond 10 years may not be retrievable. Photos or images may be subject to fees. **Please note that we cannot send expired prescriptions. Glasses have a 2-year expiration and contacts have a 1-year expiration** FEES FOR PAPER COPY OF RECORDS MAY BE INCURRED
  • If the patient is 18+ years old, consent must be noted in the patient's record that the person other than the patient requesting the information has access to the records.
    The information requested will be sent by a non-encrypted email. By checking yes, you have read or are familiar with the limits of privacy through non-encrypted email at If you check "no", we can e-mail information on other means of obtaining the records.
  • PLEASE NOTE! If you do not get an email confirmation after pressing submit, please verify the email and resend or contact us.
  • This field is for validation purposes and should be left unchanged.


HOLIDAY HOURS: Our doctor will be UNAVAILABLE for appointments from 12/9/23-12/26/2023. Please note our limited pickup days/hours for glasses: 12/11, 12/14, 12/18, AND12/20 FROM 2PM-6PM. If you need urgent assistance, please text 770-343-5467 OR call Tulman Eye Group at 770-948-0036.


We are open by APPOINTMENT ONLY. In order to be seen for the appointment, you must read and stay up to date on our health protocols Read Our Heath/Safety Guidelines Post…