Request Records

To request your records please print off and fill out this release. When filling out the release make note if you would like your x-rays or MRIs on a disc. X-ray discs are $10 and MRI discs are $20. Please include a check in the envelope or provide payment when dropping off. If you do not need your complete records and only a certain period please note that in section B. Be sure to state whether you would like the records mailed or faxed to you or if you would like to pick them up at any of our locations. Submit the completed release via mail to MOG Attn:Medical Records 4515 Poplar Ave Ste 206 Memphis, TN 38117 or you can bring it into any of our three locations.

Download Request Form