REQUEST MEDICAL RECORDS

HOW WOULD YOU LIKE TO REQUEST YOUR MEDICAL RECORDS?

Send a self-addressed stamped envelope along with the
completed Medical Records Request Form (en español) to:

Mobile Health
Attn: Medical Records Request
11-25 44th Road
Long Island City, NY 11101

Include a money order (no cash or checks) for $5.00 (10-15 business days processing) or $15.00 (5-7 business days).

Fill out the form below to request a copy of your medical records from Mobile Health (en español). Once the form is complete, you will be asked to provide payment based on your chosen processing time.

All medical records will be mailed to the address entered on this form.

1Personal Information
2Address & Delivery
3Payment

Please fill out the following information:

Date of Birth*
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For patients, schedule an appointment. For urgent appointments call 212-695-5122.