Patient Records Request

If you are a patient and would like to request a copy of your records and/or invoice, please complete and upload the form below as it is required.

Patient Request Form

MEDICAL RECORDS/INVOICES REQUESTS

Be sure to “*Select the chosen image from the images below” when prompted, or you will get an error, then, click “Submit”.

IMPORTANT: Upon receipt of the email from HealthEMS, please be sure to follow the FIRST link to confirm your account or we will not receive your request.