Proton Therapy Medical Records

How to Request Medical Records

1. Download the authorization to disclose protected health information

Authorization To Disclose Protected Health Information (English)

Authorization To Disclose Protected Health Information (Spanish)

2. Complete the form

Fill out, print, and sign the form.

3. Submit the form by fax or mail

Submit the form by fax: 469-420-9619 or mail to:

Texas Center for Proton Therapy 

1501 West Royal Lane

Irving, TX 75063

Medical records are stored at Texas Center for Proton Therapy.