Patient Consent for Release of Breast Images and Reports

If your last mammogram was performed somewhere other than Houston Methodist, we would like to get your images and reports.

• This allows our Radiologists to compare your previous images to your new images.
• By completing this form, you give Houston Methodist Sugar Land Hospital authorization to receive your images and results.

We will request your previous facility to:

• Upload all images and reports to an unencrypted DICOM compatible CD.
• Mail to:
  
  Houston Methodist Breast Care Center at Sugar Land
  16655 Southwest Fwy.
  Sugar Land, TX 77479
  
• Or allow a Houston Methodist Sugar Land courier or yourself to pick up your images and reports

*denotes required field