A Medical Records Request Form is required when you are requesting copies of medical records or asking that we disclose your health information to third-parties.  You have the option of completing the digital form below, or printing the form and mailing it to us.

The Medical Records Request Form is not valid if one or more required elements are left blank. Failure to complete all required elements may result in a delay in processing your request.

All requests, whether delivered in-person, by mail, or via fax, require 7-10 business days to process.

No same day requests will be accepted.

Digital Form Option