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Medical records

You must be 18 years of age or the parent/legal guardian to request copies of a medical record.

  • Download and print authorization form PDF.
  • Fill out the form as completely as you can.
  • Be sure to include both the name and address that you would like your records released to.
  • Be as specific as you can about the information that you'd like released (e.g., specific dates of service, specific treatment, just immunizations, etc.).
  • Please mail your authorization to the address to the right.
  • There may be a charge for copies of your medical records. If there is, we will notify you before copies are made. Once we receive your payment, your request will be processed.

Release of information
218.739.6813 | 218.736.8757 (fax)