If you are unable to complete the electronic form above, download and complete the paper form below.
The authorization form must be legible and complete. Authorizations that are illegible or incomplete will be returned. Please note the processing of records is faster using the online form above.
Records are usually available within 10 days from the time the request is received. If you are picking up your medical records in person, please be sure to bring a government-issued ID. To arrange for another individual to pick up the documents for you, please indicate that on the authorization form, and ask them to bring their government-issued ID. Only the patient, parent/legal guardian, or the patient’s legal health care representative can sign the form to release medical records. If you are requesting records on behalf of the patient or as the patient’s representative, please provide a copy of an Advance Directive/Durable Power of Attorney for healthcare / Conservatorship.
Please be advised
If you are our patient and have an upcoming appointment, you will need to request your medical images and reports from your previous facility. Please reach out to that facility to have your records sent over. If there is a delay in with us receiving your prior images, your appointment maybe rescheduled for a later date.