Medical Records Request Form - Harnett Health 2026

1. Click ‘Get Form’ to open the Medical Records Request Form in our editor.
2. Begin by entering the name of the medical practice at the top of the form. This helps identify where the records are being requested from.
3. Fill in your full name in the 'Patient Name' field, followed by your date of birth (DOB) to verify your identity.
4. In the 'Date Requested' section, input today's date to indicate when you are making this request.
5. Indicate who is requesting the records by checking either 'Patient' or 'Other', and provide additional details if necessary.
6. Select your preferred delivery method: Mail, Fax, or Pick Up. If you choose Mail or Fax, ensure to fill in the corresponding address or number.
7. Review the fee structure for obtaining records based on page count and calculate your total fee accordingly. Fill this amount in the designated area.

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