Medical Records Request (ROI)

Use the following Release of Information (ROI) form to request records from our Medical Records department. Fill out the form and drop it off with Medical Records (located in the main hospital). Hours of operation are Monday through Friday from 8:00am to 3:00pm (AZ Time). Someone will meet with you and verify your identity before accepting the request. Be sure to bring a valid, unexpired form of identification such as a driver's license. Your records request will be processed and requested items will be mailed to you at the address you list on the request.

If you have any questions, please contact Medical Records directly at 928-788-7071, Monday through Friday from 8:00am to 3:00pm (AZ Time).

Click here to access the ROI form.*

* - Note that the above link open a PDF that you can download and fill out. Our recommended program for filling out PDFs is Adobe Acrobat Reader, which can be downloaded here. Modern browsers such as Google Chrome, Mozilla Firefox, and Microsoft Edge can also open PDFs.

Medical Records Department Location and Hours of Operation

Valley View Medical Center
5330 S. Highway 95
Fort Mohave, AZ

8:00am - 3:00pm (AZ Time)
Monday - Friday

(928) 788-7071