Patient records request

Request your medical or billing records securely.

Use this secure form to request copies of your records from an MTRCM-supported practice. We will review your request and contact you if additional information is needed.

Secure

Privacy-conscious handling

Simple

Clear request steps

Supported

Help when you need it

Healthcare professional managing patient records

Your information matters

Only submit details needed to locate your records.

Patient request form

Fields marked with an asterisk are required.

Requestor information
Patient information
Records requested