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.

captcha

Testimonials
We felt so well taken care of from start to finish. We were very impressed and could not have asked for more.

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