Fill Out Your Medical Release Form
To send a written authorization to release your records or request a copy of your report or images, just download our Medical Release Form. Then, print, complete and sign the form. Please mail, fax or bring in your form with a valid picture ID for verification of your identity.
Under the Uniform Health Care Act, you may request in writing a copy of your reports and images. You may also provide us with written permission to release records (including images) to any health care provider, your spouse or other family member. Written parental consent is required for the release of non-pregnancy related information of a minor child. We will not disclose your records to others unless you direct us in writing to do so or unless the law compels us to do so. Depending on the nature of your request, a waiting period may be applicable. Records requests require a 48 hour advance notice.