Medical Records Request Letter - Template, Sample Form
✓ Valid in Nigeria
Create your Medical Records Request Letter - Template, Sample Form for use in Nigeria. Answer a few plain-English questions and the document fills in automatically as you go — then download it in Word and PDF, ready to sign or share.
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Fill in the details
0/10Type below — the document on the right updates as you go.
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Dear ________,
RE: REQUEST FOR MEDICAL RECORDS
I am a current patient at ________, and my patient ID/ health card number is ________, and I am writing to request my medical records from your practice. I am requesting my medical records to obtain a second opinion from another healthcare provider.
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My details are as follows:
Patient Name: ________
Patient Address: ________
Patient Date of Birth: ________
I understand that there may be fees associated with providing these records. Please inform me of any charges in advance and provide details on how to process the payment. Additionally, I would appreciate it if you could let me know the estimated timeframe for processing this request. If you have any questions or require more information about my request, please contact me by phone - ________, or by email - ________.
Yours faithfully,
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Fields you complete are inserted into the document live. This template is general guidance only — not legal advice.