Medical Records Request


DUE TO HIGH REQUEST VOLUME, REQUEST FULFILLMENT COULD BE DELAYED UP TO 90 BUSINESS DAYS.


PATIENTS REQUESTING COPIES OF THEIR RECORDS MUST DO SO BY CONTACTING THEIR LOCAL MYEYEDR OFFICE.


Please complete this form to request medical records for MyEyeDr patients, fill out all required fields, and upload all pertinent documentation for your request. i.e., Authorization Release, Cover Page, Transmittal guidance, etc.


Please allow between 15 - 30 business days* for your request to be processed and completed. We will send all requested records found to the requestor via fax.


*For requests containing 25 or more patients, please compile your patient list into a single Excel Spreadsheet or PDF and upload it to the designated section of the form.

 

Please select what type of request you're submitting, either an Initial Records Request or a Status Update Request for a previously submitted records request.


For requests containing 100 or more patients, the earliest Completion Date is October 1, 2025.


Patients requesting copies of their own records must do so by contacting their local MyEyeDr office.

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