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Medical Records Request

If you need images within 24 hours, please call the Medical Records DeparTment at (520) 545-1822.

Type of Request

Method of Delivery

If patient pick-up, please choose site.

If Faxing, Fax #

Please indicate date and time images are needed by. *
:


Patient DOB *

Patient Name *

Exam Requested *

Date of Exam *


Requested by *

Name of Person Requesting *

Phone Number *

Email Address

 
 

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