Release of Information

Do you need copies of your medical records for tax purposes, school, or other purposes?

Please fill out and return the form below along with a copy of your ID in one of the following ways:

1. Mail

Mail the completed form to our Administration Office (Attn: Medical Records Department): 3875 W. Beechwood Ave. Fresno, CA 93711 

2. Fax

Fax the completed form to our Medical Records Department at 1-855-771-5224

3. Drop-Off

Drop off the completed form at any of our health centers.

Please note: The completed form must be submitted with a copy of the ID of the patient or patient's representative (whoever signed the form).

Authorization for release of Information - English

Autorización para divulgar Información- Spanish