Get Request Of Records

Filling out the REQUEST OF RECORDS form is a crucial step in obtaining your medical records. This guide will help you navigate each section of the form clearly and efficiently, ensuring that your request is accurately submitted.

Follow the steps to successfully complete the form online.

1. Press the ‘Get Form’ button to access the REQUEST OF RECORDS form and open it for editing.
2. Begin by entering the date at the top of the form in the designated space.
3. Next, fill in your name in the 'Patient' field, followed by your date of birth in the corresponding section.
4. Provide the name of the doctor, clinic, or hospital from which you are requesting records in the appropriate field.
5. Enter the full address of that medical provider, including the street address, city, state, and zip code.
6. Supply the phone number and fax number of the medical provider to facilitate communication.
7. In the next section, specify the type of records you are requesting. Be as detailed as possible to ensure you receive the correct information.
8. Indicate the name of the recipient to whom the records should be transferred, which is Montaland & McGrath Chiropractic Center, along with their address.
9. Lastly, print your name legibly in the designated field and sign the form to authorize the release of your records.
10. Once you have completed the form, save your changes, and choose to download, print, or share the form as needed.

Complete your REQUEST OF RECORDS online today for efficient processing!