At HALO Breast Care Center, your medical information is important. Our goal is to make the process to request records is simple as possible.

Process for Requests

Fill out our Medical Records Request forms that are available below.

• You can fax the form to: (530) 879-4661.
• You can email a signed form to [email protected]
• You can also drop the form off at our office, located at 1720 Esplanade, Chico CA 95926.

FORMS

1. Medical Records Release – Please use this form if you would like for HALO Breast Care Center to send your records of exams completed here, to another facility.
   
   • LINK – 4 – Authorization & records Release – FROM – English
   • LINK – 4 – Authorization & records Release – FROM – Spanish
2. Medical Records Release – Please use this form if you would like HALO Breast Care Center, to request previous records, from outside facilities, on your behalf.
   
   • LINK – 3 – External Facility Medical Records Request – English
   • LINK – 3 – External Facility Medical Records Request – Spanish
3. If you have a family member, friend, or caregiver, that will pick up your medical records, please fill out the form, Designation & Consent for Medical Records Release.
   
   • LINK – 2a – Medical Records Consent – English
   • LINK – 2a – Medical Records Consent – Spanish