Information for Submitting Requests

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This website allows you to request copies of your medical record and to retrieve it electronically. Please read the important notes below before continuing to use this system:

1. This option is designed for patients only to request records to be delivered electronically through the web. Anyone else, including parents/guardians or other third parties, should click here to view other options for submitting requests.
2. In order to protect your privacy and comply with federal and state regulations, we need a copy of your driver's license or other government-issued ID before we can release your records. Failure to upload all required documents through this system within 72 hours after beginning the process will result in your request being canceled.
   • If you are on a mobile device (e.g. smartphone/tablet), you will need to electronically sign an authorization form and submit a picture of yourself holding your government-issued ID.
   • If you are on a non-mobile device (e.g. desktop/laptop computer) you will need to print, manually sign, and upload a scanned copy of an authorization form as well as your government-issued ID.
3. Information requested through this system must exactly match our established records. Typographic errors, such as patient name misspelling or incorrect dates of service, may result in your request being canceled or delayed.
4. There will be a $25.00 clerical processing and delivery fee charged.

If you are unable to complete the above, please refer to this page to review other options for submitting your request.

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