Medical Records Requests

Please complete one of the following forms to request medical records from our office or request another entity send Rogue Valley Urology your records:

Release of Information– use this form if you want to request your records be sent to another entity or request another entity send your records to Rogue Valley Urology.

Patient Requesting Access to Their Medical Record – use this form if you are requesting a copy of your own medical record.

Bend patients fax a Release of Information Form to 541-508-7968. 

Medford patients fax a Release of Information Form to 541-732-3910.