Instructions for Submitting Requests

ALERT: This system lets you as a patient or parent/guardian request that medical records be directed to a designated third party. You will not be able to access those records yourself. Only the third party will be able to access them through a secure website. If you prefer to access the records yourself and then direct them to a third party in whatever way you wish, please click here to use the short form for Urgent Care Group.

What You Need to Get Started

  1. A valid driver's license or other valid federal or state ID
  2. A credit card to make payment
  3. The name, address, and fax number of the third party to whom you are directing your records.

Please have these items handy before you start!

Important - Please Read!

NOTE: Third parties are not eligible to use this form to request records from Urgent Care Group. Only patients or parents/guardians of patients are eligible to request records using this form.


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