Ucla medical records request form 2026

1. Click ‘Get Form’ to open the UCLA Medical Records Request Form in our editor.
2. Begin by filling in your name and the name of the person or facility authorized to release your health information. Ensure accuracy for a smooth process.
3. Specify the healthcare facility from which you are requesting records, such as Westwood UCLA Medical Center or Santa Monica UCLA Medical Center. Select all that apply.
4. Indicate the type of records you wish to obtain by checking the relevant boxes, including medical records, mental health information, and any specific documents like discharge summaries or lab reports.
5. Provide the date or time period for which you are requesting information. This helps narrow down the records needed.
6. Sign and date the form at the bottom. If someone else is signing on your behalf, include their relationship to you.

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