Paper Request

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

Tampa Office: 813-524-1010

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

Mail the form to our office:

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

Fax the form to our office:

Tampa Office:  813-582-5525

Email the form to:

Paper Request

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

Tampa Office:  813-524-1010

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

Mail the form to our office:

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

Fax the form to our office:

Tampa Office:  813-582-5525

Email the form to: