Request For Medical Records

If you want information from your Clinica Family Health medical record, please complete this form and click on the “submit” button. We will provide your records as quickly as possible.

To request a Complete Medical Record, please follow the link below to download and complete the request form
Download Complete Medical Record Request Form

Para solicitar un Registro Médico Completo, siga el enlace a continuación para descargar y completar el formulario de solicitud
Descargue el formulario de Solicitud de Registro Médico Completo

Thank you.

Medical Records Request Form

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  • To request a Complete Medical Record, please follow the link below to download and complete the request form/Para solicitar un Registro Médico Completo, siga el enlace a continuación para descargar y completar el formulario de solicitud

    Download Complete Medical Record Request Form

    Descargue el formulario de Solicitud de Registro Médico Completo

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