You must be 18 years of age or the parent/legal guardian to request copies of a medical record.
- To mail in your request, please download and print our authorization form PDF and mail it to the address to the right.
- To send your request electronically, please download and save our authorization form PDF and email it to us using the Email Us link below. We will not process a request unless we have received a completed and signed Release of Information Form attached with the email.
- Fill out the form as completely as you can.
- Be sure to include both the name and address of where 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 treatments, just immunizations, etc.).
- 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.
To request an amendment to information your health record, please use this form.