Request Patient Records
Brooks Spinal Care does not release original records or X-rays. Copies of Patient records are available to Doctors offices or facilities upon request with required authorization from the patient. Copies of Cervical X-rays are available for $5 per X-ray. A copy of the 14”x36” full spine X-ray is available for $20.
Patient Information:
Patient:
Patient's Date of Birth:
For Confirmation of Authorization:
E-mail Address of Patient:
Or Patient's Phone Contact:
Doctor's Information:
Doctor's Name:
Office or Facility:
Email:
Street Address:
City:
State:
Zip:
Office Phone:
Fax:
Records Requested:
NUCCA Listing:
History:
Case Notes:
Other:
X-ray Copies (@ $5): Lateral Cervical
Nasium Pre
Nasium Post
Vertex Pre
Vertex Post
14"x36" Full Spine (@ $20):