Option #1 – Submit Your Request Online

Note: This electronic form is for medical records requests only.

Request Records

Option #2 – Submit Your Request via PDF

To complete a physical request form, download, print, and fill out the appropriate PDF below.

Medical Records Request

Print and fill out this form to request a copy of your medical records from Tower Health at Home.

Request to Amend Protected Health Information

Request to Restrict Use and Disclosure of Health Information