To Request Your Films
1.	Fill out the Authorization for Release of Health Information Form Please include the following information: • Patient Name, Birth Date, and Medical Record Number • Your contact phone number • Your signature • The description of images required • A complete address including suite number and zip code
2.	Fax the written request form to (310) 825-3205
3	Contact film library at (310) 825-6425
4.	Payment in advance is required. • $10.00 per sheet of film duplication • $15.00 for the first CD Copy $5.00 per additional CD Copy

The Imaging Library reserves the right to comply within five business days of receipt of a signed authorization and payment of applicable fees.

To Request A Written Report
1.	Fill out the Authorization for Release of Health Information Form Please include the following information: • Patient Name, Birth Date, and Medical Record Number • Your contact phone number • Your signature • The description of images required • A complete address including suite number and zip code
2.	Fax the written request to (310) 825-3356 or mail to: UCLA Release of Information 10833 Le Conte Ave, Suite BH-225 Los Angeles, CA 90095