Medical Records Request Fees

  • Requests from Patients*
    • $25.00 per request
    • plus an additional $8.00 per X-ray/MRI imaging CD
    • *Pre-payment required prior to processing a request*
  • Requests from Third Parties
    • Within the State of Texas per state statute 165.2
      • 1st 20 pages @ $25 plus additional pages over 20 @ 0.50/page
      • X-rays and Diagnostic Imaging Studies: $8.00 per CD
    • Workers Comp
      • $15.00 for pages 1-20
      • $0.30 for each additional page over the first 20 pages
    • Workers Comp Narrative Report – Preparation
      • $50.00 for pages 1-2
      • $20.00 for each additional page over the first 2 pages
    • Workers Comp Narrative Report – Copies
      • $0.50 per page
    • Affidavit Execution
      • $15.00 per affidavit
    • Notary Execution
      • $6.00 per notarized document
    • Disability Forms Preparation*
      • $20.00 for all new disability forms
      • $10.00 for any disability forms which need to be updated
    • *Pre-payment is required before Disability Forms are processed*

NOTES:

  • Requested medical records are delivered online only and are accessible via computer or mobile device. They are never faxed, mailed, or printed for pick-up.
  • Requested X-rays/MRIs are copied to CD and either mailed or picked up in-office.