Medical Records Request

How to Submit Your Request Form

All requests must come with a copy of an official photo ID (typically a driver’s license).

  • Email: Please send your request along with a copy of your photo ID to: info@achancetochange.org

  • Fax: 405-840-9017

  • US Mail:
    Mail your request, and a copy of an official photo ID, to:
    A Chance to Change
    Attn: Medical Records
    2113 W. Britton Rd.
    Oklahoma City, OK 73120     

  • In-person:
    You can complete a request with one of our front desk personnel at our facility

Typed signatures will not be accepted. All requests must be physically signed.