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Telephone: (260) 436-0259

For Patients Requesting Their Records:

Click on the button below to fill out the on line request form.  After you submit the form, a completed form will appear on your screen.  Please print the form and sign.  The signed form and a copy of your driver’s license must be faxed, emailed, or mailed according to the directions on the form.

If your request includes films or if your records must be delivered within 72 hours, please contact our office directly at 260-436-0259



Click here for online form

For All Other Parties Requesting Records:

Print, complete and fax the online form or you may also use your own records request form and fax to the above listed number. If you have a single request or your patient is already in office, please feel free to contact us directly.

*Please allow 5 to 10 business days to process your request.

If you have questions regarding a request already in progress, please call