Medical Records

Radiology Record Request

Submit a request with the online form below and records will be prepared for pickup. Please note: The images and report can be electronically forwarded to a physician office if listed as a transfer facility below. It is not necessary to come to LMH to pick up records if this option is selected.

First name:

Last name:

Date of birth:

Phone number:

( ) -

Exam requested:

Date of exam:

Format:

Radiologist written report only
Images on CD, including report
Electronic transfer of images/report to another office (choose the office)

Security code:

Enter security code: