MyUCDavisHealth -

If you are a UC Davis Health patient:

Please enter your contact information below to receive access to your own medical record.

Do not use this form to request access to a family member's chart. Please click the following link for additional information on how to request access to a chart which is not your own. How To Obtain Access To A Family Member's Chart

Improperly obtaining access to another patient’s medical records without a valid patient authorization is against State and Federal confidentiality law and is subject to fines and/or imprisonment.

By clicking “submit” you are confirming your identity as the patient stated below.

Name

First Name:

Middle Name:

Last Name:

Address

Address:

City:

State:

ZIP:

County:

DOB:

Other

Email:

Home Phone:

Mobile Phone:

Medical Record Number:

Legal Sex:

Sign up for MyUCDavisHealth for teenagers (12-17 years old)

Name

Address

Other