Please read instructions thoroughly.
If you would like to request your medical records, you must fully complete the request details and signed authorization.
Please note that some charges may apply. If they do, you must pay before your records will be processed.
If you are a 3rd party company, Insurance, Attorney, Healthcare provider or any other entity needing to request medical records please send your request with proper authorization:
Email: firstname.lastname@example.org | Fax: (972) 399-0960 | Mail: Vital Chart, 120 South Briery Road Irving, Texas 75060
If you have submitted a request already, please allow 14 business days for processing.
Click for download/print options
Fax: (972) 399-0960
Mail: Vital Chart, 120 South Briery Road, Irving, TX, 75060
**You can take an photo of the signed request with your mobile device and send the image as a JPEG (.jpg) or PNG (.png) attachment. Must be high enough quality for the request details to be fully legible.
**You can scan your signed request onto a desktop/laptop/pc and send as a PDF (.pdf) OR JPEG (.jpg) attachment.