Request Medical Records
To initiate a medical record request, click the link below to print the Revival Release of Information Form.
After completing and signing the document, please email this form to email@example.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 firstname.lastname@example.org
- 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.