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.
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.
First, we need to collect some information about the patient. If you have any questions, please contact your clinic.
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Now, we need to collect some information about you. Once we have this information, we will set up your appointment. If you have any questions, please contact your clinic.
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We need to collect some information about the patient in order to schedule this appointment. If you have any questions, please contact your clinic.
