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.