Request Imaging Records, including Films and CDs

To request a copy of your medical records, including test images (film or CD), download, print, complete and sign the applicable form below. Fax the completed form to Memorial Hermann at (713) 778-2577, attention: Request for Protected Health Information.

Record Release Forms

We process 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