Request Medical Records

Paper Request

If you have any questions, please call our medical records department.

Tampa Office: 813-524-1010

Phoenix Office: 602-755-5001

  • Request a copy of your medical records using our form. Click the button below to download and print the form. Once completing and signed, choose one of the following:

    Tampa Medical Release Form-

    Tampa Release Form Office

    Phoenix Medical Release Form-

    Arizona Medical Release Form


  • Mail the form to our office:

    Tampa Office: 3001 N. Rocky Point Dr E Suite 185, Tampa FL 33607

    Phoenix Office: 3815 E Bell Rd Suite 1400, Phoenix AZ 85032

  • Fax the form to our office:

    Tampa fax number: 813-582-5525

    Phoenix fax number: 602-755-5002