Our Patients Are Our Priority

Release (From Memorial)

MEDICAL RECORDS RELEASE CONSENT FORM. This form authorizes patients’ medical records to be released from Memorial Rheumatology. Download & FAX RECORDS TO OUR SECURE FAX: 713-360-2021

Print The Form

Download and print the form using the button to the right and fill it out with pen and paper and return it to our office.

902 Frostwood Suite 315
Houston, TX 77024


This email address is being protected from spambots. You need JavaScript enabled to view it.
Phone: 713-360-2020
Fax: 713-360-2021

Office Hours
  • Mo – Th
    8 am – 5 pm
  • Fr
    8am – 12 pm
Follow Us
© Union Dental. All rights reserved.
Powered by YOOtheme.
© Memorial Rheumatology. All rights reserved.
Powered by Elevology.