Request Medical Records From Revolution Health

~Medical Records Requests~  Patients who wish to receive their Revolution Health Medical records should print and complete the form below. It can then be uploaded as a message through the patient portal*, with subject showing as Records Request.   Any other questions or info should be done as a separate message. Write “SELF” for physician/clinic name if you want the records uploaded directly to you in the patient portal.  PLEASE ENSURE ALL OF YOUR INFORMATION IS LEGIBLE. 

To see the full announcement regarding Dr. Gorman’s retirement and Revolution Health closing CLICK HERE.

*If you are unable to access your patient portal, your completed form can be mailed or faxed (info at the top of the form).

When providing physician/clinic info, a valid FAX number must be included.  If this is left blank or is not valid, records will be uploaded to patient through the portal.  If you can’t see the form below, try a different browser or CLICK HERE

PO Box Rev_Health_Release_Records_OUT_to_Another_Provider_REVISED_052620



Leave a Reply