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Southwest Diagnostic Imaging Center

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documentRequest for Images / Medical Records

In order to release images and/or reports to physicians and/or patients, we require a signed release form.

Authorization for Release of Medical Images, Reports, and Medical Recordspdf


AdobeThe above forms are in PDF format and can be viewed using Adobe Acrobat Reader. If you do not have this application, visit the Adobe site at www.adobe.com  to download a free copy.