Medical Records Request Form


This Medical Records Request Form can be used to request a copy of your medical records from a medical facility or other health care provider. While some facilities have their own form, many do not. This form is normally used when changing health care providers or switching to a different hospital. It authorizes your records to be sent to the new health care provider, hospital, or medical facility.

We offer the free Medical Records Request Form in Microsoft Word as well as a paid PDF form. The Word file will automatically download so check the folder where downloads are saved on your computer or mobile device. The PDF will open in a new window so you can print or save it.

Medical Records Request Form

Click the link below to download the Medical Records Request Form in Microsoft Word format for free.


WORD – Medical Records Request Form

PDF (fill-in-the-blanks) – Medical Records Request Form

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This medical records request form and other legal forms available on this website are provided “as is” without any express or implied warranties of any kind including, but not limited to, warranty of merchantability or fitness for any particular purpose.

It is your responsibility to determine if the Medical Records Request Form is legally adequate for your needs.

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We do not assume any legal liability or responsibility for the accuracy or usefulness of the legal forms generated by the templates we offer.

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