Medical Records Release Form at Apt Urgent Care in Manvel, TX

If you need to obtain your medical records please read and fill out this form. For more information contact us or schedule an appointment online. We are conveniently located at 10447 Bailey Rd Suite 170 Manvel, TX 77578.

HIPAA authorization for the use or disclosure of health information

To request authorization for a medical record release: please click here, print and fill out the form in its entirety, and return it in person to the clinic. Patient health information (PHI) is either faxed to the named recipient or printed and given in person. WE DO NOT accept requests via email and WE DO NOT email PHI to any party under any circumstances. Charges will apply.

Medical record release occurs Monday through Friday only. Please allow 3 – 5 business days for the request to be processed and completed. If you have any questions, please call the clinic at 346-488-1872