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:
- Download Request Medical Records Form complete, sign and date it. Be sure to have it signed by a Witness.
- 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.).
- Please indicate the dates of services for which you are requesting.
- Please indicate the type of records needed.
- 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:
If you have any questions, please call the medical records department at 281-557-5678.