Patient Education

PLEASE NOTE: There is a minimum copy fee of $25.00 to copy and process your Medical Record Request. Please see the Copy Fee information listed to the right of this box for complete information regarding your request for medical records.
  1. Print the Authorization to Release Information Form.

    Right-click to download

  2. Complete, Sign and Date Form.

  3. Return form to the Carrell Clinic™ by:

    • Fax to CC ROI Department at (214) 397-1564
    • Hand Deliver to the Administration Office located on the 4th floor of Tower I
    • Mail to The Carrell Clinic™
      Attention: ROI Department
      9301 North Central Expressway
      Tower 1, Suite 500
      Dallas, TX 75231
  4. Carrell Clinic™ will process your request and contact you.

    Please allow 7 to 10 Business Days to complete your request. Once the completed release form is received in the ROI Department, your request will be processed.