There are several steps to successfully completing this form.
For the best experience, please fill out the form using Google Chrome.
- Before you begin completing this form, please scroll to the bottom of the page and click the blue ‘continue’ button. This will make the form turn from gray to white and the highlighted fields will then be clickable.
- Once the mandatory red asterisk fields are complete, a blue ‘click to sign’ box will appear.
- After you click the blue box, you will be prompted to enter your email address.
- Please check your inbox for an email from Adobe Sign and click confirm my email address.
- Your medical records request is now complete and has been securely submitted to our office. Within a couple minutes, you should receive a signed copy of your request from Austin Retina in your email.
If you have any issues with the steps listed, please contact our office at (512) 451-0103, option 1, and ask to be connected to the medical records department.