Looking for a Form?
Check out our forms page to find specific forms to download including new patient registration forms, medical records requests, and more.
Patient Forms Policy
Effective April 2017, all patient forms will be completed within 7-10 business days. This timeline starts the day forms are received by our office.
All forms are completed in the order in which they are received.
Please be advised that if our office is unable to contact you for required information, the completion of your forms may be delayed.
If you have any questions please call our office and speak with a staff member.
Do you have questions regarding your medical records request or our office policies? Call our office and speak to one of our friendly staff members!
Call our office at 804-378-1800.
Questions can also be answered via a secure message on our patient portal! You can access our portal through the link below or if you haven't registered you can start the process today!
Richmond Spine Interventions and Pain Center's medical records department is dedicated to providing you with the highest quality service, please read the information below and if you have any questions please don't hesitate to ask.
Medical Records Request:
It is your right as a patient to have access to your medical records. In order to obtain your medical records, you must submit a medical records request form which is available for download below.
*Unfortunately, due to HIPAA laws, we are unable to release records received from other providers offices. You must request those records directly from that provider's office or medical records department.
Medical records requests are processed within 5 business days. Should you have any questions regarding your request please call our office. In order to submit your medical records request you can send it to the following:
Mail: 3420 Pump Rd. #160, Richmond, VA 23233
Drop-Off: 14404 Sommerville Ct. Midlothian, VA 23113
Medical Records Release:
At times our providers will need information from other doctors or facilities that have provided you with care in the past. In order for us to obtain those records, we must have a signed consent form which gives us permission to request that information. That form can be downloaded below and sent to your doctor's office. If you need assistance with this process, please inform our office staff.
*If we have not seen you as a patient we are not able to request your medical records. Those records must be obtained by the patient.
Medical Records for Legal Purposes:
If medical records are required for legal purposes, please have your lawyer's office call our medical records department for further information. Our medical records department can be reached at:
Medical Records Fees:
Currently, we do not charge a fee for patients who are requesting their medical records. For all other parties requesting records, please contact our medical records department for a fee schedule.