Banner Rehabilitation Hospital Contact Us Form

For further information about our medical rehabilitation services, billing or general inquiries, please provide us with the information listed below.

Request Medical Records

Copies of medical records can be obtained by submitting a written request to our Medical Records Department or by faxing a request. For your convenience, a copy of the Patient Access and Authorization form (PDF) can be printed, signed and sent to the addresses or fax numbers below.

Patient Access and Authorization form (Spanish)

Banner Rehabilitation Hospital West
12740 North Plaza Del Rio Blvd.
Peoria, AZ 85381
Medical Records Fax: (623) 600-7017

Banner Rehabilitation Hospital Phoenix
775 East Willetta Street
Phoenix, AZ 85006
Medical Records Fax: (623) 600-7051

NOTE: In accordance with state law, a fee may be charged.

Careers/Internships

Please visit our Careers page for job listings.

Questions? Contact Us

I am ...

Please select correct option

Looking for ...

Your First Name

Your Last Name

Your Email Address

Your Phone Number

Your Preferred Contact Method

Your Zip Code

Your State

Your City

Your Organization/Affiliation

Patient First Name

Patient Last Name

Patient Email Address

Patient Phone Number

Patient Preferred Contact Method

Patient Zip Code

Patient State

Patient City

Patient Account Number (if available)

Questions/Comments /50005000

Reason for Request /50005000

Treatment Location

Banner Rehabilitation Hospital Contact Us Form

Request Medical Records

Careers/Internships

Questions? Contact Us

Find a Doctor Near You