Request your current medical records by completing the the electronic release below.


1. You can not input your name, it will populate when you add your signature at the end.

2. Fill out your info, and your doctors information. We must have both to get your records released.

3. Apply your signature, a copy of the form is emailed to you

4. Open your email to verify your identity. We will now have your signed release

**Mobile users please click here for Medical Records Release if form below says thumbnail not avaiable. READ INSTRUCTIONS ABOVE FIRST