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Kelsey-Seybold Clinic – Conroe Family Medicine fax number

(713) 442-5732

Medical Records Department

Used for: Medical records release/transfer

Fax destination details

Department
Medical Records Department
Purpose
Medical records release/transfer
Form
Medical Records Release Authorization Form — Medical Records Release Authorization Form
Address
690 S Loop 336 West, Ste 222, Conroe, TX 77304
Voice phone
713-442-6661

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  • Confirm that this exact department handles your document or request.
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  • Include a cover sheet and any case, member, claim, or form reference required.
  • Keep the delivery confirmation with your submission records.

Fill patient name, DOB, indicate which records to release (e.g., all medical records, labs, radiology, notes), specify date range if needed, sign and date; authorization valid for 60 days.

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