Medical Records Request

To request medical records, please fill out these forms and email to cmorton@texaschildneurology.com

***If you are a patient of Dr. Gossett’s needing your records sent to Neurology Consultants of Dallas, please email Crystal at cmorton@texaschildneurology.com your child’s first name, last initial and DOB with the subject as Referral to NCD. She will send the referral electronically. You do not need to fill out the forms above and there is no charge to send the referral. ***

Texas Child Neurology does not charge for medical records that are sent to a licensed Texas health care provider, insurance company, or state agency.

Medical Records can be faxed, emailed, mailed, or picked up at Texas Child Neurology.  For email requests, written permission must be obtained. Emails sent from Texas Child Neurology are encrypted, but that does not guarantee their safety.

The fees for medical records are $10.00 for the first 20 pages and $.25 for each page thereafter.  Please note that if the record is extremely large, these requests are outsourced to Photostat for processing.  All legal requests are also outsourced to Photostat.  The fee must be paid in advance before records are released from Texas Child Neurology.  

Please allow up to five business days for all nonlegal requests.

If you have any questions in regards to filling out the form contact our medical records staff member Crystal Morton either by email at cmorton@texaschildneurology.com or by phone at 972-769-9000 Ext. 2132.