Main Clinic
3555 Knickerbocker Rd.
San Angelo, TX 76904
Executive Drive Clinic
3605 Executive Dr.
San Angelo, TX 76904

Medical Records Release

ATTENTION: As of July 1, 2013 the rate charged to patients for medical records has changed.

When records are provided directly (hand delivered or mailed) to the patient or a legal representative of the patient:

One free copy per year (only for records stored on site).

Additional copies within the same year:
The first 20 pages are free, then 20¢ per page after
OR
A flat fee of $10 to burn a CD (only for records stored on site)

For records stored in archives (information prior to 1999):
$15 for retrieval of the chart; the first 50 pages are free, then 20¢ a page

Phone: 325-224-5264
Fax: 325-224-5913

To request a copy of your medical records, click on the link below to open and print the authorization form. Complete the authorization form and bring in or fax to our Records Release Office.

All blanks must be filled out. If you have any questions or need assistance when completing the form, please contact the Records Release Office.

Records release form to obtain a copy of YOUR medical records.

Records release form for a FAMILY MEMBER to obtain a copy of your medical records.

Records release form for PSYCHIATRIC records.

Records release form for PSYCHOLOGY records.