L
o
a
d
i
n
g
.
.
.

Health Records Release

If you’re interested in requesting your health record, please print and sign this form.

Submit your signed form to staff in Medical Reception or fax it to (510) 261-6438 for Oakland and (415) 417-3501 for San Francisco.

We process requests as soon as possible; please allow up to 10 business days.

If you need additional information, please call us at (510) 535-4429 for Oakland and (415) 417-3500 for San Francisco.

Questions?  Call or text (510) 535-4400 for Oakland and (415) 417-3501 for San Francisco.