Request Medical Records

How to Request Medical Records

To obtain a copy of your medical records, you will need to complete the following form: Download The Request Medical Records Form Please read the Form Instructions carefully to avoid any delays in getting your medical records: 

Form Instructions: 

  1. Download Request Medical Records Form complete, sign and date it. Be sure to have it signed by a Witness.
  2. In order to validate your authorization, please provide a legible copy of a valid photo I.D (e.g., driver’s license, military I. D. or state I.D.). 
  3. Please indicate the dates of services for which you are requesting. 
  4. Please indicate the type of records needed. 
  5. If the patient is a minor, 17 years or younger, the request must be signed by a parent or his/her legally qualified representative. Proof of legal representation will be required. 

Form Delivery

1. Mail it or deliver it in person to the medical records department at 

   Houston Physicians’ Hospital
   Attn: Medical Records
   333 N. Texas Ave, Ste 1000
   Webster, Texas 77598

2. Or fax it to: 281-557-5687 

3. You may scan your signed forms and valid photo ID to:

    This field is for validation purposes and should be left unchanged.

If you have any questions, please call the medical records department at 281-557-5678