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Imaging Centers, Breast Centers and Labs

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Request Imaging Records

For all Memorial Hermann Imaging Center customer service needs, complete the form below or call (713) 778-2545 during normal business hours, Monday – Friday 8 a.m. – 5 p.m.

Request Films, CDs and Other Services

Complete the form below to request medical records, including your test images (film or CD). You will be asked to sign an authorization form when your records are released.

Patient Requests

We can handle patient requests for:

  • Test reports
  • Images (films or CDs)
  • Film reprinting for all studies
  • Importing images from outside CDs for comparison reads
  • Business Office questions
  • Scheduling
  • Insurance verification

Physician requests

We can handle physician requests for:

  • Reports, images, comparison reads or questions regarding reports
  • Lab results
  • CDs of images
  • Importing images from outside CDs for comparison reads
  • Film reprinting for all studies
  • Updating physician profiles
  • Adding physicians to our systems

Authorization to Release Patient Information

You may request your test images and records by phone or fax. Please be prepared to give patient name, date of birth, type of study, physician name and address and date / time needed.

Phone: (713) 778-2545 (option 1 for physicians)
Fax: (713) 778-2577

Clinical Forms

To help expedite your visit, you can print and complete your clinical forms ahead of time. Please be sure to bring all completed forms with you to your appointment, along with:

  • Doctor’s order for the exam
  • Medical insurance card(s)
  • Driver’s license or other identification card
  • Form of payment (we accept credit cards)
  • Completed clinical forms

Please note: Additional forms, including consent forms, may need to be completed upon arrival.


Patient Information

  First name
  Last name
  E-mail address
  Contact phone (xxx) xxx-xxxx
  Date of birth mm/dd/yyyy

Procedure Info

  Type of test performed
  Approximate date of test
  Type:

Report of Exam
  Date records needed
  Please note another tests needed

Select a Delivery Method

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