To place a request for records, download and complete the release of information form below. A valid request form must be completed in its entirety including a detailed description of the information to be released and client signature. Incomplete requests cannot be processed and will therefore be discarded.
Requests are processed within 15 business days upon receipt and may incur a charge for printing. Records are released in accordance to HIPAA as well as state and federal laws.
All requests for records should be directed to firstname.lastname@example.org or sent by fax to 972-499-6935.