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Please complete the entire records request form. It is important that every section be filled out.Submit records request using traditional paper Release Form​​ Complete ALL sections of the PATIENT REQUEST FOR PROTECTED HEALTH INFORMATION form. To request medical records from a specific provider, choose from the list below, download the form, and submit to your doctor's office. Instructions for Using this Form. You can also follow the instructions below to request copies of your medical records. To Request Your Medical Record. We can process requests for copies of both inpatient and outpatient medical records. 3. Click the button to search public records. "Click here to search public records" button. 4.