910-762-3882

Records Request


Requests for records to be sent to a physician that did not order the study must come directly from that physician ’s office. To request your personal medical records, please utilize the form link below.

Medical Records Release Form

Upon receipt, your request will be processed within 48 business hours. However, in order to allow referring physicians to first review exam results, Delaney will not process medical records requests until 5 business days after the date of service. Normal business hours are Monday – Friday, 7:30am – 5:30pm, excluding holidays. If you need assistance, please call (910) 341-1840.

You may alternatively download registration and other forms from our website, print them, fill them out and bring them with you to your appointment. All patients should complete the Patient Registration Form, the Conditions of Examination Form, and Receipt of Notice of Privacy Policy. If you are having a mammogram, please complete the Breast Imaging Patient Registration Form too. If you are having an MRI, please complete the MRI Screening Record, and the MRI Brain, Spine and Orthopedic History Forms if they are applicable to your particular scan.

To view the forms listed below, you will need Adobe Reader. You may download Adobe Reader for free at www.adobe.com. Please bring your completed forms with you to our office at the time of your visit.

Download Patient Forms

If you are unable to do any of the above, don’t worry, we will take care of you when you arrive for your appointment! We do ask that you come prepared with your insurance information and medical history in any event. Thank you for your cooperation!