New Patient Paperwork

To request a copy of your medical records, please complete and sign a Medical Records Release Authorization Form.

Please include:

• Full name
• Date of birth
• Phone number
• Where records are being sent
• What records are being requested
• Signature and date

Requests may be submitted by:

• In person
• Fax
• Email
• Mail

Please note:

• Records cannot be released without a signed authorization.
• Photo ID may be required.
• Processing times may vary.
• Fees may apply for copies, if allowed by law.

Consumer Access to Health Records & Complaints

If you have questions, concerns, or complaints regarding your medical records, you may contact the applicable licensing or disciplinary authority for this office:

Texas Board of Chiropractic Examiners / Texas Department of Licensing and Regulation (TDLR)
P.O. Box 12157
Austin, TX 78711
Phone: (800) 803-9202 or (512) 463-6599
Website: TDLR complaint page

You also have the right to file a consumer complaint regarding your medical records or privacy rights under Texas Health and Safety Code Section 181.103 with:

Texas Attorney General – Consumer Protection Division
File online through the Texas Attorney General’s consumer complaint portal.
Website: Texas Attorney General Consumer Complaint page

For additional information about your medical privacy rights and how to file a complaint, you may also visit the Texas Attorney General’s medical privacy page.