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MEDICAL RECORD REQUEST FORM (for you and your family)

Home / MEDICAL RECORD REQUEST FORM (for you and your family)
RSRS stores the medical records of doctors from across Canada. To request a certified copy of your personal medical record, please fill in the form below and we will contact you as soon as possible. Note: Patients are encouraged to always keep a copy of their own personal records.


  •      (Someone outside your family? Click here.)
  • Request additional records:

    Please list any additional family members for whom you are requesting medical records. Include Date of Birth for each as well as the date when each last saw the doctor.
  • First nameLast nameDate of BirthDate Last Saw Doctor 
    Add a new row

  • For emergency matters only. If you select this option, immediately call 1-888-563-3732, Ext. 205 and leave a message explaining your extraordinary circumstances and timeline.


  • A Release of Information Form must be completed and signed prior to the release of any medical information. If you do not have one, we will supply you with one.
  • You are entitled to a COPY of your patient record. An original paper record is the property of the physician and must be retained in storage for a period of time, after which it is shredded.
  • Each patient of legal age or older must sign for the release of his/her own record.
  • There is a fee for the transfer of medical information. The fee is set in accordance with guidelines. The fee is not prohibitive and records are not withheld once properly authorized for release.

If you have any problems using this form or if you have questions, please contact RSRS by telephone at 1‑888‑563‑3732, Ext 1 or email info@rsrs.com or send a FAX to 1-877-398-5932.