MEDICAL RECORDS REQUEST FORMS

Patient Instructions for Medical Record Requests

We outsource our release of information process to HealthMark Group. To follow up on the status of your medical record request, you may contact HealthMark directly at 800-659-4035 or status@healthmark-group.com.

HealthMark fulfills all patient requests for personal copies at no charge to the patient. A complimentary copy of your record will be made available through HealthMark’s website, https://requestmanager.healthmark-group.com.

You may also submit a request electronically to HealthMark by registering for an account athttps://requestmanager.healthmark-group.com/register. Once logged in, you may select Submit Request from the menu options and enter all required fields to submit an authorization to HealthMark directly. HealthMark will process your medical record request and provide notification via mail or email once complete. A complimentary copy of your record will be made available for you to download through HealthMark’s Request Manager.

Select Release Form

Request medical records be released to Dallas Pain Consultants

Record Release to DPC

Request medical records be released from Dallas Pain Consultants

Record Release from DPC