Paper Request

If you have any questions, please call our medical records department.

Tampa Office: 813-576-0467

Phoenix Office: 623-267-2656

• Request a copy of your medical records using our form. Click the button below to download and print the form. Once completed and signed, choose one of the following:

Tampa Medical Release Form-

Medical Release Form

Phoenix Medical Release Form-

Medical Release Form

• Mail the form to our office:

Tampa Office: 3001 N. Rocky Point Dr. E, Suite 185, Tampa, FL 33607

Phoenix Office: 3815 E Bell Rd Suite 1400, Phoenix, AZ 85032

• Fax the form to our office:

Tampa fax number: 813-582-5525

Phoenix fax number: 602-755-5002

• Email the form to

Tampa Office: customercare@lifeguardimaging.com.

Phoenix Office: customercarephx@lifeguardimaging.com