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 free PDF form. The Word file can be printed as is so you can fill in the blanks by hand. It can also be customized in case you want to change, add, or delete sections. The PDF version is chosen most often by users who want to print the document and fill in the blanks.

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

WORD – Medical Records Request Word

PDF – Medical Records Request PDF

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

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