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Medical Records and Documentation Request

Important Information You Should Know

Requests for Medical Records & Fees

We must have your signature on a release form in order to release your records. For this reason, we cannot process requests made by telephone or e-mail. In order to obtain a copy of your medical records, please download the Authorization for Release of Medical Information. Complete all fields on the form, sign it, and mail or bring the form to the Medical Records Department of University of North Texas Health Science Center, 855 Montgomery Street, PCC 102, Fort Worth, Texas 76107. Please remember to include your contact information so that we may contact you should we have any questions. If you are unable to download the form here, you may also pick one up in person.


Fees:

Patient Request for Records:

First twenty (20) pages:

$25.00

Every page after first twenty (20) pages:

$0.50 per page

NOTE: UNT Health Science Center requires pre-payment of medical records fees from patients requesting copies of their records.
Forms:



Contact Us

Address: 855 Montgomery Street, PCC 102
Fort Worth, Texas 76107
Telephone: (817) 735-2185
Fax: (817) 735-0210