Request for Medical Records

Please complete the form below if you'd like to receive a copy of your own medical records. Once received, you are of course welcome to further re-transmit it elsewhere (e.g. other health care professionals involved in your care).

Alternatively, you may also ask third-parties to send us a signed authorization requesting the relevant documents.

In either situation, there may be a administrative charge for this service, depending on the scope of your request and the amount of administrative and physician time it requires to process the request.

It may take up to 10 business days for us to complete this request, again depending on the scope of your request.

Patient Name *
Patient Name
Knowing the reason helps us supply the right records that you need
Please supply a phone number to reach you at, in case the info that we have on file is no longer up to date.
Acknowledgment *

If you are requesting to receive your records on a USB key, kindly wait until instructed to come to the clinic with the USB key.  This way we can ensure your records are ready for you when you arrive.