Medical Records Pick-Up Request

Patients may request to pick-up medical records at a DR imaging center. To submit a pick-up request, complete the online form below and allow 24 hours for processing.  DO NOT use the below online form for legal cases. All legal medical records requests MUST be submitted via HealthMark.

Name
Invalid Input

Date of Birth(*)
Invalid Input

Date of Exam(*)
Invalid Input

Phone(*)
Invalid Input

Email Address
Invalid Input

Pick-up location(*)
Invalid Input

Comments
Invalid Input

CAPTCHA(*)
CAPTCHA
RefreshInvalid Input