Medical Release Authorization
In order for us to send you a copy of your medical records, you must complete a Medical Release Authorization form. To obtain a copy of your records click here to download a General Medical Records Release. The release form must be completely filled out. Failure to complete the form in its entirety may delay the release of your records. FAX the completed form and a copy of your ID to the Medical Records Department at 972.573.0648 or email to firstname.lastname@example.org. We comply with the Texas Medical Board Rules, please give us 15 days to process your request. If you have questions or need assistance completing the form, e-mail questions to email@example.com.