Patient Forms
Medical Record Request Form

Patients can submit a Medical Request form from our Patient Portal. Those who are not registered on our patient portal can request a copy of their medical records by downloading and filling in our Medical Records Request Form below. This form can then be mailed or faxed to our business office at 1812. S. Alameda Corpus Christi, TX 78404: Fax Number: 361-883-4310.

It is essential that you provide us with this information to protect your privacy and to ensure that you receive the correct results. Information cannot be released unless the form is completely filled out, including correct contact information, specific dates of service, and that it is properly signed and dated.

Please note: Appropriate identification will be requested upon pick-up of any medical information. If any person other than the patient is to pick up records on behalf of the patient, a written note by the patient authorizing such pick-up is required. Any request for distribution to an address other than the patient billing address or the ordering physician must be made in writing.

Any questions regarding Medical records can be directed to our Medical Records department at 361-561-3011.

Link to download form: Medical Records Release Form

Patient Portal Proxy Access Form

If you would like your family member or caregiver to act as your proxy on our patient portal, you must download and fill in the Proxy Access Form. This form must be signed by the patient and returned to one of our office locations. Proper identification will be required in order to enable proxy access.