Digestive Health Associates

Southwest Endoscopy Center

Medical records contain federally protected health information.  This form must only be executed by appropriately authorized individuals.  Family members are not permitted access to an individual's protected health information on the basis of their relationship alone, and a family member "signing" on behalf of another, without legal authority to do so, may constitute forgery and fraud.

Please call us if you have any questions or we can otherwise assist you with your medical records request.

Additional information is available near the bottom of our "Forms Online" page.