Instructions

There are 3 methods you can use to request your medical records:

  • 1. Open, complete, and submit online the medical records request form along with required fee.
  • 2. Download the printable request form, complete it, sign it, and mail it along with required fee.
  • 3. Download the printable request form, completed, signed it, and fax it. You may pay the fee by using this secure website and credit card or you may mail cashier’s check or personal check.

You may call “Medical Records Custodian” and leave a recorded message to address any other questions.

Mail Instructions

Want to submit your paperwork through the mail?

Download the form below and mail completed/signed form along with payment in full to:

Medical Records Custodian
Post Office Box 164
Athens, TX 75751

Medical Records Processing is $20 USD. We accept personal checks and cashier's checks made payable to: Ronald D. Cates, MD

Printable Form

Fillable Online Request Form

PLEASE NOTE: If not submitted by selecting the “SUBMIT” button BEFORE closing this page, this form WILL NOT BE SAVED. All information recorded, if not submitted by selecting the “SUBMIT” button, will be deleted when this page is closed. Before beginning, have available all of your information required to complete this form in total and during the same sitting.

Fillable Online Request Form

Pay Online

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