Medical Record Request


 

 Please click here to review the Dallas Orthopedic and Shoulder Institute Notice of Privacy Practices.

For fastest service, please use the following table with instructions for medical records and FMLA/disability form requests.

For additional questions, please call 214-256-3778 ext. 105 or email forms@theshouldermotion.com

 

How do I decide which option to use?

Release to you

(the patient, for personal records

or another physician’s office)

3rd party medical record release (attorney, disability, insurance)

FMLA/Disability Forms

How long will it take to process my request?

Immediately, utilizing the patient portal HERE. Or,

7-10 business days after payment has been received

7-10 business days

7-10 business days with the signed request.

Click HERE for the request form.

How much will this cost?

Patient portal: FREE!

Written Request for paper records: $25 Diagnostic imaging on CD: $10

Medical records: $25

Billing Records: $25

Diagnostic imaging on CD: $10

Affidavit: $15

$25

Where do I submit my request?

Quickest option (recommended):

Patient Portal - no request required!

By fax only: 214-256-3770 Make sure to include signed medical record release with request

Please submit your request HERE:

*In-person submission will only delay your requests.

Click HERE for the required form for

written requests. Submit by email to forms@theshouldermotion.com

Can this request be expedited? (72 business hours)

N/A

Yes, with an additional $25 fee

Yes, with an additional $25 fee

Will I be notified when my request is ready?

Yes, only if the medical records are to be picked up.

N/A

Yes, by your choice of text

message or email

Can I access my own records?

Yes, please use the patient portal for access.  

If you do not know your patient portal login, you can still log in using your phone number along with other identifying factors

N/A

Once the forms are complete, you can access them using the

online portal.

How can my records be delivered?

Immediate download or email

available on the patient portal.

Fax or FedEx

($25 additional fee applies for FedEx)

Fax or FedEx

($25 additional fee applies for FedEx)


NOTICE: No SAME DAY requests will be processed.

 

 

 

 

Location
Dallas Orthopedic and Shoulder Institute
222 South Collins Road, Suite 101
Sunnyvale, TX 75182
Phone: 469-213-2093
Fax: 214-256-3770
Office Hours

Get in touch

469-213-2093