Medical information release from a USMD Imaging Center 


Use this form to ask the USMD Imaging Center to send your medical records to another facility.

Download and complete the form below. The form must be signed, no typed names are allowed.

View or download

Submit your completed and signed form to the medical records department by doing one of the following:

6333 North State Highway 161, Ste. 200
Irving, Texas, 75038

Due to the closure of all imaging centers, image discs will be promptly mailed to either the patient, the physician or the new imaging center, based on your preference.

If you have any questions or specific delivery instructions, please don't hesitate to reach out to our dedicated support team at medical.records@usmd.com.