Please contact your previous place of service to get a copy of your records either sent to yourself or FAX / mailed to us prior to your first visit. Thank You. Dr. Rob Gerowitz Optometrist - Orthokeratologist Mission: Myopia Control, P.C. 2723 Sheridan Rd, Suite C c/o The Inn on Sheridan, Zion IL 60099 AUTHORIZATION FOR THE RELEASE OF HEALTH INFORMATION RECORDS THIS AUTHORIZATION IS BEING COMPLETED BY: _____ PATIENT _____ LEGAL REPRESENTATIVE On _____ / _____ / _____