Request Form

The Centeno-Schultz clinic is happy to provide your medical records to you or parties which you authorize. In order to have your medical records copied and released to you please download and compete the form then mail, fax, e-mail or drop off the form.

Click here to download the form

You can fax the form to:
303-429-6373

You can mail the form to:
The Centeno-Schultz Clinic
Attn: Medical Request
11080 Circle Point Road
Building 2, Suite 140
Westminster, CO 80020

If your records are going to anyone other than your doctor there will be a fee. For more information on these fees please call The Centeno-Schultz Clinic.