Request submitted

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

A confirmation has been sent to {{ v.reqEmail }}.

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.

Call (602) 603-2282

Step {{ stepNum }} of 4

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? Fax them to (602) 847-8268, 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, a court order, or a subpoena that meets Arizona and federal requirements. We review each one before releasing records. 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 or fax it to (602) 847-8268.

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) * Email for the invoice *

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

Please complete the following before continuing:

• {{ e }}

Request your medical records.

Request submitted

{{ stepTitle }}