Records Request Form

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Thank you for reaching out to our Records Request department.

The standard processing time for records requests is 7-14 business days. Releasing records directly to the patient requires fewer steps and is therefore a faster process.

You can always email us at recordsrequests@bebravehealth.com to request expedited processing for a specific reason or to get a status update. We will respond to your message within 1 business day.

Email *

Option 1

Clear selection

Who is filling out this records request form? *

I am the patient

I am the patient's legal guardian

I am filling this form out on behalf of a Brave patient

Other:

Name of Patient *

Birthdate of Patient *

YYYY

Phone Number of Patient (or Legal Guardian) *

What records or documentation are being requested? *

All medical records

Other:

What timeframe are you requesting?

Would you like the records released directly to the patient? *

Yes

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