MEDICAL RECORDS
Request Medical Records
To initiate a medical record request, click the link below to print the Revival Release of Information Form.
Revival Release of Information Form.
After completing and signing the document, please email this form to info@builtbyrevival.com or fax at 866-720-1055. Your request will be completed within 10 business days.
Send Medical Records
To send medical records you can use the following options:
- Email to info@builtbyrevival.com
- Scan and fax to 866-720-1055.
- Bring a printed copy to your appointment
A team member will contact you in 1-2 business days to confirm that your records were received.