Request submitted

Thank you, {{ v.reqFirstName }}. Your records request has been received. {{ successFeeNote }} Records are delivered by your selected method.

Confirmation Number

A confirmation has been sent to {{ v.reqEmail }}. Keep your confirmation number for reference.

Next step: reply to that email with your documents

Reply to the confirmation email from Canyon Pain Center and attach:

We start processing your request once they arrive. Can’t find the email? Check your spam folder, or call (602) 603-2282.

Questions? Call (602) 603-2282

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Who is requesting these records? *

{{ relLabel }} * Organization / firm (if any)

First Name * Last Name * Email Address * Phone Number *

Patient information

Patient Legal First Name * Patient Legal Last Name * Patient Date of Birth * Approx. last date of service (optional)

Which records do you need? * Select all that apply

Date range of records *

From To

How should we deliver the records? *

Purpose of request (optional)

{{ onFileLabel }}We’ll confirm it’s current before releasing records.

Practice name * NPI number * Practice fax *

Send your documents by replying to our email

There’s nothing to upload here. After you submit, we email a confirmation to {{ emailDisplay }}. Reply to that email and attach:

A clear phone photo or a PDF scan is fine. Would rather not email them? Bring them to our office at 702 E Bell Rd, Suite 112, Phoenix, or call (602) 603-2282.

I’ll reply to the confirmation email with these documents.We can’t release records until they arrive.

Third-party requests need a HIPAA release signed by the patient, or a subpoena or court order. If the patient hasn't signed one yet, call our office at (602) 603-2282 for the authorization form, have the patient sign it, and attach it when you reply to our confirmation email.

Mailed copy fee

Covers copies and postage. Electronic delivery is free. We’ll email a payment link before mailing.

Fee schedule — third-party requests

Minimum due (retrieval fee) {{ totalDisplay }}

Reasonable reproduction fees under A.R.S. § 12-2295. Nothing is charged today: once the records are located and the page count is confirmed, we email an itemized invoice with a secure payment link. Records are released when the invoice is paid.

Where should we send the invoice?

Bill to (firm / company) * Invoice email *

Case / claim reference (optional — printed on the invoice)

Please complete the following before continuing:

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Request your medical records.

Request submitted

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