Request Medical Records - Integrity Rehab 2026

1. Click ‘Get Form’ to open the Request Medical Records form in the editor.
2. Begin by entering your name and date of birth in the designated fields. This information is crucial for identifying your medical records.
3. Indicate the time period you were a patient at Integrity Rehab by filling in the 'between' section with the appropriate month and year.
4. Select all applicable options regarding the type of records you wish to request, such as Medical Records or Billing Records, by checking the corresponding boxes.
5. If you are sending records to a medical provider, ensure to provide their email address in the specified field.
6. Complete the section for releasing information to another person if necessary, including attaching any required documents like Power of Attorney.
7. Fill out your payment method preference and provide your contact details, including phone number and email address.
8. Finally, review all entered information for accuracy before signing and dating the form at the bottom.

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