Request Imaging Records, including Films and CDs

To request a copy of your medical records, including test images (film or CD), download, print, complete and sign the applicable form below. Fax or email the completed form to Memorial Hermann at (713) 778-2577 or Please note, Attention: Request for Protected Health Information.

Record Release Forms

We process patient requests for:

  • Test reports
  • Images (films or CDs)
  • Film reprinting for all studies