Medical Records Requests

Here is information regarding medical records requests and form completion charges.  Our printable Medical Release Form can be found here.

NO FEE for requests to doctors office for visit or 1-2 pages within 6 months of visit, otherwise ..

$25.00 for 1st 20 pages and 25 cents for each page thereafter or at Urology Team discretion

DISABILITY, ATTORNEYS, AND INSURANCE FORMS

$20.00: 1 page
$35.00: 2 - 5 pages
$50.00: 6 - 10 pages

For completion of the following forms:

Disability, FMLA, Social Security or Insurance Forms (HRA, HSA, Preexisting conditions for insurance approval, parking permits, return to work forms required by employer (should employer not accept UTPA form)

Payment is required with the presentation of paperwork.