Patient Imaging Release
Patient Imaging Release
Please allow the Medical Record Department 24-48 hours to contact you regarding the details of your request from the time of your submission.

Please complete the form below if you would like a copy of your medical records sent to RAI from another facility. This form can also be completed if you would like your medical records sent from RAI to another facility.

    Contact Information

    Patient Information

    Facility Information


    Study Information

    *Type of Study


    Statement of Release

    RAI Radiology Affiliates Imaging

    Radiology Affiliates Imaging offers highly specialized experience in every facet of radiology, utilizing current and progressive protocols with the most innovative techniques for diagnostic imaging and therapeutic intervention.