Requesting Patient Records

Please allow 3-5 business days for obtaining your records
  • Patients 18 years of age are considered adults and therefore must request their own records.
    If the person requesting records is anyone other that mother or father, please submit credentials to after completing this form. Thank you!
  • Please add the amounts from fees listed in 'type of request' and 'method of records release' sections. If applicable, a payment link will be sent to you.
  • Authorization for the Release of Protected Health Information

    Only a parent or a legal guardian can request or consent to sharing of patient records. Please allow 3-5 business days for processing your request. This authorization is only applicable for services selected above and only upto the date of request. Any additional request for release of protected health information will require a separate authorization. Authorizing the disclosure of this healthcare information is voluntary. Once the information has been released according to the terms of this authorization, the information cannot be recalled.
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