Medical Records Request Form

“Processing time is 7 business days”

If you would like to request your medical records, please perform the following

1. Submit the form below
2. Fill out and email us a completed HIPAA form along with a copy of your picture ID.
We will not be able to email your medical records. We are only able to fax them to your doctor or you may pick them up.













    Patient’s Email address

    Notes: