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 a state agency.

Medical Records can be faxed, emailed, mailed, or picked up at Texas Child Neurology.  If the request is for the records to be emailed, written permission must be obtained.  Texas Child Neurology does have encrypted email, however, you must know even encrypted emails are not always safe.

The fees for medical records are $10.00 for the first 20 pages and $.25 each page thereafter.  Please note 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 Paris either by email or by phone 972-769-9000 Ext. 2126

Click the form above to open and fill out.

Please print form, fill out and sign, then return to or via fax 972-769-0035 ATTN: Paris