Medical Record Request Instructions

Texas Child Neurology does not charge for medical records that are sent to a licensed Texas health care provider, insurance company, or state agency.

Medical Records can be faxed, emailed, mailed, or picked up at Texas Child Neurology.  For email requests, written permission must be obtained. Emails sent from Texas Child Neurology are encrypted, but that does not guarantee their safety.

The fees for medical records are $10.00 for the first 20 pages and $.25 for each page thereafter.  Please note that if the record is extremely large, these requests are outsourced to Photostat for processing.  All legal requests are also outsourced to Photostat.  The fee must be paid in advance before records are released from Texas Child Neurology.  

Please allow up to five business days for all nonlegal requests.

If you have any questions in regards to filling out the form contact our medical records staff member Paris Robinson either by email at or by phone at 972-769-9000 Ext. 2126

Click the form above to open it and fill it out. Please print the signed form and return it via email or fax to: or 972-769-0035 (ATTN: Paris)