Renton, Seattle & Tacoma

Medical Records Request

To Obtain A Copy Of Your Medical Records

Please complete and sign these request forms, following the instructions below:

1. Records can be faxed, mailed, or picked up at the clinic. In the “To:” section of the Medical Release form, tell us to whom and how/where the records are to be released. Examples of this section:

      • To: Dr. Smith at Fax #: 555-555-5555
      • To: Dr. Washington at 1111 W 5th St. Somewhere WA 55555
      • To: Myself-Pick up at Renton Clinic

2. Give a current phone number in case there is a question about the request.

3. Copy of ID needs to be included with the record release forms.

4. The release & ID can be dropped off at the clinic, faxed to 509-575-0477, mailed to 106 East E Street Yakima, WA 98901 or sent through the form form below:
 

Your Name (required)

Your Phone (required)

Your Email (required)

Mailing Address in USA, Canada or Mexico:

City, State, Postal Code:

Your Message

Attach signed request form & copy of ID here:

Type this validation code into the box below.

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Testimonials
You went above and beyond to make sure I got the help I needed financially and emotionally.

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Cedar River Clinics
October 23, 2014 at 5:11 pm

Thank you to these Washington State senators!
"Because Hobby Lobby is based only on a federal statue, states are free to make laws and regulations requiring employers to cover women’s reproductive health care in their insurance plans.
Our state senators intend to accomplish this through the state’s anti-discrimination laws. It’s a sound strategy."

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State could trump Hobby Lobby decision | Editorials | The Olympian

www.theolympian.com

A group of Washington state senators hopes to prevent discrimination against women by employers who refuse to offer contraceptive coverage in their health-care plans. A bill they plan to introduce in the 2015 Legislature would overturn the effects of the U.S. Supreme Court’s Hobby Lobby decision in…

Cedar River Clinics
October 21, 2014 at 8:54 pm

Washington Voters - You have received your ballots in the mail. Please vote! Every election is important. NARAL has done all the research. Click here for their fabulous pro-choice voter guide.

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NARAL Pro-Choice Washington Voter Guide

www.prochoicewavotes.org

A woman's right to choose is under unprecedented attack. Washington has not been immune to the wave of anti-choice fervor that is sweeping the country. With the 2014 U.S. Supreme Court decisions limiting access to safe and affordable reproductive health care, electing pro-choice champions to pass st…