If you would like a copy of your medical records – please fill out the attached form, titled “Medical Records Release Authorization,” and send the signed form to us for processing.
Download your Medical Records Release Authorization form here: Medical Records Release Authorization
Please send the signed form using ONLY ONE of the following methods:
- Upload your request electronically to HealthMark Group by registering for an account at www.medrelease.com/360. Once logged in, you may select “Submit Request” from the menu options and enter all required fields to submit an authorization to HealthMark Group directly. HealthMark Group 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 Group’s MedRelease 360 website.
- Email your request to firstname.lastname@example.org.
- Fax your request to (512) 450-1339.
- Mail your request to 900 W 38th Street, Suite 300, Austin, TX 78705
***Please note that you only need to use ONE of the above options***
To follow up on the status of your medical record request, you may contact HealthMark Group directly at 800-659-4035 or email@example.com. HealthMark Group 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 Group’s website, www.medrelease.com/360. First time users are required to register for an account before accessing the website.