Records Request Now Hiring State-Wide Make A Referral Areas We Serve Frequent Questions Make A Payment Submit Information Consent I agree to the pricing policyPursuant to Oklahoma State Code 76 OS 1986, Section 19 : Fees for Records Include: $0.50 per page for printed records $0.30 per page for electronic records $5.00 electronic delivery fee $10.00 starting rate on postage fees for mailed records $20.00 fee if records are needed sooner than 30 days Requests for medical records from attorneys, insurance companies and by way of subpoena shall be charged a base fee of Ten Dollars ($10.00) in addition to the per page charges required plus postage or delivery fee. I understand that I may be contacted for payment before records are released. Records requests will be fulfilled within 30 days of submission unless the rushed processing fee is paid. Client's Name(Required) First Last Client's DOB(Required) MM slash DD slash YYYY Client's Insurance ID List any previous names records may be under Name of Person Submitting the Request(Required) Full Name Requestor's Relationship to Client(Required) Self Parent/Guardian Other Requestor's Phone Number(Required)Requestor's Email Address(Required) Enter Email Confirm Email I would like the records delivered via(Required) Email Postal Service Fax Picked up in person Records are only available in person at 6216 S. Lewis Ave. Ste. 102, Tulsa, OK 74136 Monday - Friday 9 am - 5 pmFax Number(Required)Mailing Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Upload any applicable Release of Information formsMax. file size: 50 MB.Please upload a copy of your ID or the parent/guardian ID(Required)Max. file size: 50 MB.Limitations Acknowledgement(Required) I understand the limitations to receiving recordsLimitations to Receiving Records: A person who is or has been a consumer of a physician, a licensed mental health professional as defined in Section 1-103 of this title, a licensed alcohol and drug counselor as defined in Section 1871 of Title 59 of the Oklahoma Statutes, a mental health facility, a drug or alcohol abuse treatment facility or service, or other agency for the purpose of mental health or drug or alcohol abuse care and treatment, or such person’s treatment advocate as defined in Section 1-109.1 of this title, shall be entitled to personal access to his or her mental health or drug or alcohol abuse treatment information, except the following: 1. Information contained in notes recorded in any medium by a mental health professional documenting or analyzing the contents of conversation during a private counseling session or a group, joint or family counseling session, and that is separated from the rest of the patient's medical record; 2. Information compiled in reasonable anticipation of or for use in a civil, criminal or administrative action or proceeding; 3. Information that is otherwise privileged or prohibited from disclosure by law; 4. Information the person in charge of the care and treatment of the patient determines to be reasonably likely to endanger the life or physical safety of the patient or another person; 5. Information created or obtained as part of research that includes treatment; provided, the patient consented to the temporary suspension of access while the research is ongoing. The patient's right of access shall resume upon completion of the research; 6. Information requested by an inmate that a correctional institution has determined may jeopardize the health, safety, security, custody or rehabilitation of the inmate or other person; and 7. Information obtained under a promise of confidentiality and the access requested would be reasonably likely to reveal the source of the information.Do you need these records rushed? $20 processing fee(Required) Please Rush Process within 30 days Δ