to main content

Release of Medical Records

Choose an Option Below to Obtain a Copy of Your Medical Records

Option 1: You can request your medical records through MyKelseyOnline (MKO)

MyKelseyOnline (MKO) provides you with online access to your medical record. It can help you participate in your healthcare, communicate with your providers, securely request and view records online on a timely basis.

MyKelseyOnline (MKO)

Option 2: Request your Medical Records Online (Adobe Sign Documents) to be transferred to Kelsey-Seybold Clinic

For English Use This Form
For Spanish Use This Form

This form will automatically send your request to Kelsey-Seybold Clinic for processing.

Option 3: Request your Medical Records to be transferred from Kelsey-Seybold Clinic using a printable PDF.

If you would like to request your medical records to be transferred from Kelsey-Seybold Clinic.

For English Use This Form
For Spanish Use This Form

When you complete and sign the form, you authorize the release of your medical records to a healthcare provider of your choice. You may return the completed form to our Medical Record Department or Radiology Department for processing in two ways:

Medical Record Department:

  1. By faxing to 713-442-2804.
  2. By mail to:
    Kelsey-Seybold Clinic - Meyerland Plaza
    Attn: Release of Information Department
    560 Meyerland Plaza Mall
    Houston, TX 77096

Radiology Department:

  1. By faxing to 713-442-1175.
  2. By mail to:
    Kelsey-Seybold Clinic – Radiology Department
    2727 West Holcombe Blvd.
    Houston, TX 77025

For assistance with your request, you may contact the departments below:

Medical Record Department: 713-442-5700

Radiology Department: 713-442-1168