Request Medical Records from Doctor

Write this type of letter when you are asking your doctor to send your medical records from your care at their office. You will typically ask them to send the records directly to you or to another doctor or health practitioner. If you want them to send the records directly to another practitioner, specify the address, email address, or fax number to which they should send the records.

[Your letterhead, if desired; if not, your return address]

[Date of letter-month, day, and year]

[Recipient's first and last names]
[Company name]
[Street or P.O. box address]
[City, State ZIP code]

Dear [recipient's name]:

I have been a patient at your office between August 2005 and January 2011. I have recently moved out of state and am therefore changing my medical care to a different doctor's office. Please send all of my medical records from my time of treatment at your office to this address:

Dr. Robert Jones
123 Main Street
Philadelphia, PA 21520

If you have any questions, please call me at (215) 555-1212. Thank you for your prompt attention to this matter.

Sincerely,

[Signature]

[Sender's first and last names]

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