Medical Release Forms
Medical Records Request Form
The old site exposed this route directly, so we preserved it here for patients, employers, and authorized representatives who need records-release support.
What to prepare
Bring identifying details, the specific records or date range requested, and the recipient information if records need to be released to a third party.
Need help first?
Call (703) 361-4357 if you need help confirming what form or authorization details are required before submitting a records request.
Records request access
The legacy site embedded a secure Google Form at this step. We’re preserving that workflow while keeping this route stable for search engines and returning patients.