You may request Medical Records by completing the medical records release form and returning it to our office.  You may call 817 410 5077 and request your records but you must return the form before the records will be released.  You may use fax, postal mail or bring it to our office.  You may also write a letter to make your request.

Include the following information:

• Your name, including your maiden name (if applicable)
• Social Security number
• Date of birth
• Address and phone number
• Email address
• Record(s) being requested
• Date(s) of service (months and year)Signature
• Delivery option (pick-up, postal mail)

How much does it cost to get my records?

$25.00 for the 1-20pages and $0.50 for pages 21+
$10.00 for additional imaging discs

Cash or Checks only for Medical Records

Medical release form