Forms and Documents

Medical Records Request

To obtain your medical records, please complete the steps below.

Please note that it takes 10 business days to complete most medical records requests.

  1. Download and complete the Medical Records Request Form.
    CLICK HERE TO DOWNLOAD MEDICAL RECORDS REQUEST FORM
  2. Return the form by mail or fax: (626) 796-2488.
  3. After receipt of the the request, you will be contact by Health Care Institute confirming receipt.
  4. Please allow 10 business days after receipt of confirmation to receive your records.
**Please note that there is a $15 charge for all personal medical records request. The amount is due before we send out your medical records.

Letter & Form Completion Request:

If you need a medical form or letter to be completed by one of our providers, please do the following:

  1. Download and complete the Medical Records Request Form.
    CLICK HERE TO DOWNLOAD LETTER & FORMS REQUEST
  2. Return the form by mail or fax: (626) 796-2488.
  3. After receipt of the the request, you will be contact by Health Care Institute confirming receipt.
  4. Please allow 10 business days after receipt of confirmation to form completion of your forms or letter.
**There may be a charge to complete your form or letter depending on the nature of your request. The minimum charge is $15. You will be notified if there is a charge to complete your request before your request is filled.