DialClerk Directory

SimonMed Imaging

Records, fax and other contacts

Find other published document channels. Confirm the department and purpose before sending any records.

fax other

Medical records — release authorization

Official page read
Phone

No phone listed for this route

Fax

602-302-5958

Published email

MedRecReq@simonmed.com

Completed authorization-to-release form and required identity documentation for medical-record requests

Published hours

Not published in this record

Product, plan and location

Confirm the exact product or service
National contact — confirm product and location

Mailing address

Not researched for this route

Use the current Authorization to Release Protected Health Information form and follow its identity requirements. The linked English form is marked 1.26 and has PDF creation metadata January 14, 2026. The patient portal is an alternative for sharing available exam records. No branch fax is substituted for this records fax.

View source ↗ · Source checked 2026-10-22 · simonmed records form ↗

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Make the call count.

Find other published document channels. Confirm the department and purpose before sending any records.

Have ready in your secure workspace

  • Recipient department and exact document request
  • Required release or authorization
  • Secure return contact and existing request reference

Questions to resolve

  • Is this the correct destination for this document type?
  • Is there a secure portal or required form?
  • How is receipt confirmed?

This is a general administrative checklist, not payer policy or advice about a particular patient. Confirm the current plan instructions.

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