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.
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Union Dental
Location

902 Frostwood Suite 315
Houston, TX 77024

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Phone: 713-360-2020
Fax: 713-360-2021

Office Hours
  • Mo – Th
    8 am – 5 pm
  • Fr
    8am – 12 pm
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