Medical Records Request - Next Level Urgent Care

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Patient Care
COVID-19
- COVID-19 Testing Options
- COVID-19 Vaccine
Locations
- Baytown
- Champions
- Cinco Ranch
- Conroe
- Copperfield
- Cypress
- Falcon Landing
- Katy
- Kingsland
- League City
- Long Meadow
- Meyerland
- Pearland
- Sienna Plantation
- Sugar Land
- Tanglewood
- The Woodlands
About Us
Employer Solutions
Research

Open 7 Days a Week Until 9PM

Medical Records Request

Please complete the form below and we will return your paperwork within 24 hours.

Name of Patient's Legally Authorized Representative *

First

Last

Email *

Phone *

Please upload the completed medical records release form. *

Click or drag a file to this area to upload.

Do your forms require notary service?

Yes
No

Total

$ 0.00

Stripe Credit Card *

Card

Name on Card

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