Sample Letter Requesting A Copy Of Your Medical Records

Sample Letter

TO BE TYPED OR WRITTEN LEGIBLY ON YOUR STATIONARY OR A PLAIN PIECE OF PAPER

(DATE)

Dr. Michael Perez

331 W. 43rd St.

New York, NY 10029

Attn: Beth Wright, Medical Records Department

Re: Medical records request

Dear Ms Wright,

Per our telephone conversation, I am requesting a copy of my medical records. I am specifically requesting all doctor's notes, lab tests and x-ray reports from December 1998 to the present.

I will be moving in six weeks and wish to supply my new physician with my medical information. (This sentence is optional, as you do not have to provide a reason for your request. You may be requesting the records for many reasons, ranging from acquiring a second opinion to insurance purposes). Please mail the records as soon as possible to.

Dr. Norma Jean Wilson

861 Strathmore Avenue.

Baltimore, MD 21215

Please send me a copy of your cover note for my file.

Thank you for your assistance.

Sincerely,

_______________________

Signature (include full name, no notarization required)