Request Your Medical Records

You have a right to see your medical records or get copies. You may receive your medical record at no charge for care provided by:

  • SpineOne
  • Park Meadows Imaging
  • The Surgery Center at Lone Tree
  • Park Meadows Anesthesia

We will make records available in a timely fashion. If we’re not able to make records available at the time of request, we will inform you of the status and produce your medical record within 21 days from the receipt of the request. If the information requested does not exist or cannot be found you will be notified within 15 working days.

To Receive a Copy of your Medical Records

Start by downloading and filling out the form below:

Authorization for Disclosure of Medical Records and Protected Health Information (Pdf)

After you have filled out and signed the form, choose one of the following options to send it in:

Fax the completed and signed form to 303-951-7528

Bring the completed and signed form to our location at 8500 Park Meadows Drive, Suite 200  Lone Tree, CO 80124

Scan the completed and signed form and send it to us using the contact form on this page. In order to process your request, you must include:

  1. Your written signature
  2. A copy of your photo ID
Step 1: Upload your signed authorization (if available)

Upload a copy of your ID (if available)
Step 2: Provide your contact information below
First Name*
Last Name*
Email*
Phone*
*required field
Step 3: Press "Send" and our Records department will contact you soon!

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