I want a copy of my medical records for myself:

If you want a copy of your medical records from HealthNet, please fill out this form. Once you have completed this form, please send it back to HealthNet by: 

I need my old doctor to send my medical records to HealthNet:

Please fill out this form to give HealthNet permission to get your medical records from your old doctor. Once you have completed this form, please send it back to HealthNet by: 

If your old doctor sends you your medical records, please bring them with you to your scheduled visit. 


I need to get my medical records from HealthNet to give to another provider, attorney, or other group:

If you need to get your medical records from HealthNet to give to another provider, attorney, or other group, please fill out this form. Once you have completed this form, please send it back to HealthNet by: