Protect your privacy
Please do not include medical details in the email subject line or message body. Attach the completed form instead. Contact our team if you need help with a secure submission option.
SIMPLE REQUESTS. THOUGHTFUL SUPPORT.
Your records.
A clear process.
Download the fillable form, complete and sign it, then follow the submission instructions below.
Medical Records Request & Authorization · 3 pages · PDF, 2.3 MB
REQUESTING YOUR MEDICAL RECORDS
Follow these three steps.
Complete all applicable fields and sign the authorization before submitting.
- 01
Download the form
Use our original fillable Medical Records Request & Authorization form. Complete it electronically, or print a copy.
Download fillable PDF ↓Open PDF in a new tab ↗ - 02
Complete & sign
Enter the patient and recipient information, identify the records requested, and sign and date the authorization.
- Include a working phone number
- Complete all applicable sections
- Review the form and save a copy
- 03
Email your request
Attach the completed, signed form and email it to:
javon.oliver@olivetree1care.netSubject: Medical Records Request
Email your request ↗Please attach your form before sending.
PROCESSING YOUR REQUEST
Please allow 5–7 business days.
Processing begins after we receive a complete, signed request. We will contact you if additional information is needed.
business days
Need assistance?
Have a question about the form or your request? Our team can help.
Call 202-340-1953 ↗javon.oliver@olivetree1care.net