Paper Request

If you have any questions, please call our medical records department.

Phone

Phoenix Office: 602-755-5001

Request a copy of your medical records using our form. Click the button below to download and print the form. Once completed and signed, choose one of the following:

Phoenix Medical Release Form

Mail the form to our office:

Phone

Phoenix Office: 3815 E Bell Rd Suite 1400, Phoenix, AZ 85032

Fax the form to our office:

Phone

Phoenix fax number:

602-755-5002

Email the form to:

Phone

Phoenix Office:  customercarephx@lifeguardimaging.com