Roundtable Medical Consultants (RTMC)

Request Medical Records

The RoundTable Medical Consultants (RTMC) Patient Medical Records Department processes all requests for release of protected patents health information.

Hours of Operation:

Monday through Friday
8:00 AM to 4:30 PM CST

Contact Information:

Tel. : 832-699-3777 (Option 3)
Fax : 832-327-7616

To request a confidential patient health record, please follow these steps.

STEP 1: Complete the Patient Records Request Form (Step 1 below) online, then download/print before signing the form.
Please Note: We DO NOT accept DocuSign or electronic signatures.

STEP 2: Complete the online form (Step 2 below) and attach your completed and signed Patient Record Request Form along with a copy of the patient’s photo  ID/Drivers License, then submit the form to us.

STEP 3:  If applicable: After completing the above steps, scroll to the bottom to PAY for your confidential patient health record request.

PLEASE NOTE:
– Statements cannot be generated until finalized with the insurance company.
– Requests for records from multiple emergency room locations will incur separate charges.
– Be sure to attach all requested documents before submitting the form to us.

Not sure how to complete the forms below or how to proceed? Please watch these short videos.

If you are a patient requesting your own personal medical records, complete the pdf form (Step 1) below, print a copy, sign the copy, scan and attach it to the form (Step 2) along with a copy of your ID/DL, and send it to us.

Patients Requesting Own Records – Complete the pdf form below, print, sign and upload it along with your Photo ID/Drivers License in Step 2.

Medical Records Release Form 1

Attorneys – Attach and upload any additional documents including an attorney request form along with the pdf form from Step 1 and patient’s ID/Drivers License.

"*" indicates required fields

MM slash DD slash YYYY
Patient's Full Name (Enter Name of the Patient)*
MM slash DD slash YYYY
MM slash DD slash YYYY
Requester's Name (Enter Name of Requester)*
Drop files here or
Accepted file types: jpg, jpeg, pdf, png, gif, Max. file size: 100 MB, Max. files: 30.
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    Attorneys, insurance companies and record retrieval companies requesting patient medical records ARE REQUIRED to pay for them.  The following entities ARE NOT required to pay for medical records – Sheriff’s Office, Police Depts., DEA, Medical Examiner, TX State Medical Board, Nursing Board, Judges, Courts, and All County Entities.

    Please click below to pay for your medical record request using PayPal or Credit/Debit Card.

    Medical Records Request Questions.

    Got Questions About Requesting Patient Medical Records? We’re here to help!

    We know you may have questions before deciding to request your or a client’s medical records. Please see our answers to the most frequently asked questions (FAQs) from our clients. If you can’t find answers to your questions, reach out to Medical Records Dept., at 832-699-3777 (Option 3) during normal business hours or complete this short form and we will get back to you.