Patient Rights and Instructions: Medical Records and Complaints
In compliance with Texas Health and Safety Code Section 181.105 (HB 4224), Revival Chiropractic provides the following step-by-step instructions regarding your rights to access your medical records and your right to file a consumer complaint with the applicable licensing authority.
How to Request Your Medical Records
Under the rules of the Texas Board of Chiropractic Examiners (22 TAC § 76.2), you have the right to request and receive copies of your patient records. Please follow these steps to submit your request:
Step 1: Submit a Written Request All requests for medical records must be made in writing. The request must be signed by you (the patient) or by a person legally authorized to act on your behalf.
Step 2: Include Required Details Your written request must clearly state:
• The specific information or records you want to be disclosed (e.g., "all records from 2025," "initial assessment and x-rays," or "complete medical file").
• The name and contact information of the person or entity to whom the records should be sent.
Step 3: Submit Your Request to Our Office You may deliver your written request to our front desk during normal business hours or mail it to our clinic address.
Step 4: Pay Applicable Fees Under Texas law (22 TAC § 76.3), reasonable administrative fees may apply for providing records. We will notify you of any fees within five (5) business days of receiving your request. Advance payment may be required. The maximum allowable fees are:
Record Format
Maximum Allowable Fee
Digital-only format
$50.00 (for routine records)
Paper-only copies
$25.00 for the first page, plus $0.25 per additional page
Non-digital films/imaging
$50.00 for the first page, plus $1.00 per additional page
Note: Actual costs for mailing, shipping, or notarizing documents may be charged separately.
Step 5: Receive Your Records Once we receive your written request and any applicable fees, we will provide your records within fifteen (15) business days.
How to File a Consumer Complaint
The Texas Board of Chiropractic Examiners (TBCE) investigates complaints against licensed chiropractors. If you have a concern regarding the care or services provided, you have the right to file a complaint.
Step 1: Gather Necessary Information - Before filing, ensure you have the full name and practice address of the practitioner involved. You should also prepare specific dates and a detailed description of the incident or allegations.
Step 2: Choose Your Filing Method - Complaints must be submitted in writing; anonymous complaints are not accepted. You may choose one of two methods:
• Option A: File Online (Recommended) Visit the TBCE Online Complaint Portal at https://db.tbce.texas.gov/fmi/webd/TBCE_Complaint_Portal and click "Submit Via Online Complaint Form." Follow the prompts to complete and submit your complaint electronically.
• Option B: File by Mail Download and print the Complaint Form PDF from the TBCE website at www.tbce.state.tx.us. Complete the form and mail it to:
Texas Board of Chiropractic Examiners
Attn: Enforcement Department
333 Guadalupe, Tower III, Suite 825
Austin, Texas 78701
Step 3: Contact the Board for Assistance (If Needed) - If you have questions about the complaint process, you may contact the TBCE Enforcement Department directly:
• Phone: (512) 305-6707
• Email: enforcement@tbce.state.tx.us
• Website: www.tbce.state.tx.us
This document is provided to comply with Texas Health and Safety Code Section 181.105. It is recommended to post this document on the clinic website and in a visible location at the physical facility.