Information transfers are handled electronically. Requests for medical records are typically processed within 48 hours of the request.

Requesting Electronic Copies Of Your Child's Medical Record

Please use the form below to request copies of your children's Medical Records. Please note the demographic information listed below must match the information listed on your account. Patients over the age of 18 must request their own health records.




Important Note:

In order to process your request you will need to set-up a secure account with "Reach my Doctor". Patient medical records can only be exchanged using this account. Use the link below for detailed instructions on setting up a "Reach My Doctor" Account.

Download PDFReach my Doctor


Medical Records Request Form

Demographic Information
Your Name: :
Relationship To Child::

Street Address: :
City: :
State: :
Zip Code: :
Phone Number: :
Email :
Child 1
Child Name :
Date of Birth: :
Child 2
Child's Name :
Date of Birth: :
Child 3
Child's Name :
Date of Birth: :
Child 4
Child's Name :
Date of Birth: :

(Please include all children you are requesting records for);
Records Requested

(Please specify Date Range Below)
Beginning Date: :
Ending Date: :
Reason for Request:

Patients Transferring Out
Reason For Transferring Out of Practice::

Other Comments:
Security:Enter the code exactly as you see it in the image:
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