There are several steps to successfully completing these forms.
For the best experience, please fill out the forms using Google Chrome.
- Before you begin completing these forms, please scroll to the bottom of the page and click both blue **Form** buttons. This will open the online patient registration form in a new tab.
- 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.
Medical Records Release Authorization
Allows patients to authorize Austin Retina to send their medical records to an external recipient.
Medical Records Request Authorization
Used to request and authorize the transfer of a patient’s medical records to Austin Retina from an outside provider.
