For Physicians
Request Medical Records (Patient Request)
Use the form below to request a copy of your medical records. We strive to respond within one business day. We can only email records to the email address we have on file — if you need records sent to a different email, please call us at (877) 775-3377.
Please Note
- We strive to respond to requests within one business day.
- We can only email records to the email address we have on file. If you need records sent to a different email, please call us at (877) 775-3377.
This form is hosted on Jotform's HIPAA-compliant servers. Do not include sensitive medical information unless specifically requested by the form.