Free Request Letter for Medical Records Template
Request Letter for Medical Records
August 8, 2095
Dr. John Smith
Medical Records Department
Springfield Medical Center
456 Oak Avenue
Springfield, IL 62701
Dear Dr. Smith,
I am writing to request copies of my medical records from Springfield Medical Center. I have been a patient at your facility and require these records for personal use and continuity of care with my new healthcare provider.
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Below are my details for reference:
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Please include the following records in the request:
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I understand there may be a fee associated with processing this request. Please inform me of any costs, and I will promptly provide payment. If possible, I would prefer the records to be sent electronically to my email address: [Your Email]. Alternatively, you may mail the records to the address listed above.
Should you require any further information or have questions regarding this request, please contact me at 555 - 1234 - 789. Thank you for your prompt attention to this matter.
Sincerely,
[Your Name]
