Medical Records Request

Please contact us at 713-791-9966 to request records. A minimum fee of $25.00 applies. You may download the release form here:

Medical Records Request Form

You may use the following form to upload and send the completed document:

Fields marked * are required


Terms of Use*
By checking the box on the contact form, you agree to the Terms of Use listed here: Communications through our website or via email are not encrypted and are not necessarily secure. Use of the internet or email is for your convenience only, and by using them, you assume the risk of unauthorized use. By checking this box you hereby agree to hold DermSurgery Associates, its doctors and affiliates, harmless from any hacking or any other unauthorized use of your personal information by outside parties.
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Back to Top