Request for Medical Records Online

Request a copy of your medical records online

I have always enjoyed their professionalism.
—Mobile Health Patient

En Español Medical record requests are available online via this form. All required fields must be completed and payment must be made after clicking on the Buy Now button at the bottom of the form.

Medical records are mailed to the address entered on this form and are available in two delivery speeds:

  • Processed and mailed within 10-15 business days. ($5)
  • Processed and mailed within 2 to 3 business days. ($25)

Medical records may still be request via the mail. Click for instructions.
If you have questions about your medical record request, please contact Mobile Health directly.

Please complete all required(*) fields below to request a copy of your medical record:

Delivery Speed:

*First Name: *Last Name:
*Email Address: *Phone Number:

*Street Address: Apartment Number:
*City: *State:
*Zip: *Last 4 Digits of SSN:

*Date(s) Requested:

NOTICE: You must complete payment on the next page to submit your request.
Your request will NOT BE PROCESSED until you receive a payment confirmation from Paypal.