Request Medical Records
To ensure patient confidentiality is protected at all times, “Release of Information” forms must be signed by patient prior to the release of information to attorneys, another physician, insurance companies or patient.
![Patient Request Link]()
Patient Request Link
![FollowMyHealth]()
FollowMyHealth
![Fax: (801) 374-2615]()
Fax: (801) 374-2615
Patient Request Link
It’s easy to request a digital copy of your medical records. Click below to complete your request online from any device and your records will be delivered right to you – no need to go and pick them up!
FollowMyHealth
Access all your medical records through Revere Health’s patient portal, FollowMyHealth. It’s free, secure, and convenient and keeps you in touch with every aspect of your healthcare.
Legal/3rd Parties
1. A valid and complete Authorization for Release of Health Information Form signed and dated by the patient is required to request medical records. If needed, download and complete the Authorization for Release of Health Information Form.
* For specific records, provide the name, address, and phone number of the facility or provider on the authorization form. Otherwise, you may use ‘Revere Health’.
2. Return the completed form to one of the options listed above. This form is to be used for third party record requests where patient authorization is required. Examples include requests coming directly from insurance companies or legal offices.
NOTE: There will be a fee for providing copies of medical records. Medical records requests will be filled within 30 days of your request.
![Phone: (801) 429-8062]()
Phone: (801) 429-8062
![Fax: (801) 374-2615]()
Fax: (801) 374-2615
![Mail: Revere Health Release of Information - 1055 N 500 W, Provo, UT 84604]()
Mail: Revere Health Release of Information - 1055 N 500 W, Provo, UT 84604
