Medical Record Request

If you would like to give us some feedback on our service and to comment on those areas that you feel were exceptional and those below par, please take the time to fill out our survey or leave your thoughts in our testimonial section.

On a scale of 1 to 10, with 10 being best please rate the following categories.

To request your medical records, please fax your medical record request to 661-631-9257 or walk into the clinic and the receptionist will process your request. There is a usual $35 fee for your records. You will need to show proper ID to verify your identity. If a third party or family member is sent to pick up the medical records, you will need to have them added to your file before they are authorized to receive your medical records.

Medical Records/Subpoena Request:

Please input your client’s information and attach your subpoena/letter of representation.

First Name

Last Name

Contact

Patient Address

City

State

Postal Code

Patient Date of Birth

Referring Physician Name

NPI Number

Referring Physician Phone Number

Reason for Referral/Patient Diagnosis Information

How Should We Contact Regarding This Referral?

Fax Number

Submit Your Form

Patient Survey

Patient Testimonial

Downtown Clinic

5300 California Ave. Suite 110
Bakersfield, CA 93309

Monday – Friday:
9 AM – 6 PM
Saturday & Sunday:
Closed

Phone: (661) 631-8793 x1

Northwest / Aquatic Center

3850 Riverlakes Dr Suite A
Bakersfield, CA 93312

Monday – Friday:
9 AM – 6 PM

Sunday: 9am to 4pm
Saturday Closed:

Phone: (661) 529-2303 x1